Lichy C, Reuner K H, Buggle F, Litfin F, Rickmann H, Kunze A, Brandt T, Grau A
Department of Neurology, University of Heidelberg, Germany.
Cerebrovasc Dis. 2003;16(1):83-7. doi: 10.1159/000070120.
Paradoxical embolism via persistent foramen ovale (PFO) is suspected to be a frequent cause of stroke in younger patients. We investigated whether the prevalence of the risk factors for venous thrombosis factor V Leiden (FVL) and prothrombin G20210A mutation (PT G20210A) is increased in this group of patients.
We examined FVL and PT G20210A mutation in 220 patients (group 1) with cerebral ischemia associated with a PFO and without other etiology, in 196 patients with cerebral ischemia of an etiology other than PFO (group 2), and in 362 healthy subjects (group 3) from the same region in Germany.
Heterozygosity for the PT G20210A mutation was more common in group 1 (5.0%) than in group 3 (1.4%; sex- and age-adjusted odds ratio 3.66; 95% CI 1.25-10.75; p = 0.01). By contrast, the mutation was not more common in group 2 (2.6%; odds ratio 1.50; 95% CI 0.42-5.41; p = 0.5). Prevalences of FVL were not different between groups.
We identified PT G20210A but not FVL - the strongest genetic risk factor for deep venous thrombosis - to be significantly associated with stroke attributed to PFO. These findings rise doubts about the concept of paradoxical brain embolism as the dominating mechanism in stroke associated with PFO.
经持续存在的卵圆孔未闭（PFO）发生的反常栓塞被怀疑是年轻患者中风的常见原因。我们调查了这组患者中静脉血栓形成的危险因素即凝血因子V莱顿突变（FVL）和凝血酶原G20210A突变（PT G20210A）的患病率是否增加。
我们检测了220例伴有PFO且无其他病因的脑缺血患者（第1组）、196例由PFO以外的病因导致脑缺血的患者（第2组）以及来自德国同一地区的362名健康受试者（第3组）的FVL和PT G20210A突变情况。
PT G20210A突变杂合子在第1组（5.0%）中比在第3组（1.4%）中更常见；经性别和年龄调整后的优势比为3.66；95%置信区间为1.25 - 10.75；p = 0.01。相比之下，该突变在第2组中并不更常见（2.6%；优势比1.50；95%置信区间0.42 - 5.41；p = 0.5）。各组间FVL的患病率无差异。
我们发现PT G20210A而非FVL（深静脉血栓形成最强的遗传危险因素）与PFO所致中风显著相关。这些发现对反常性脑栓塞作为与PFO相关中风的主导机制这一概念提出了质疑。
