Vila Nicolás, Millán Mónica, Ferrer Xavier, Riutort Nadal, Escudero Domingo
Neurology Service, University Hospital Germans Trías i Pujol, Carretera de Canyet, 08916, Badalona, Spain.
Stroke. 2003 Sep;34(9):E168-9. doi: 10.1161/01.STR.0000085085.20390.A3. Epub 2003 Jul 31.
Abnormalities of dermal connective tissue have been detected in patients with spontaneous cervical artery dissections (sCAD), suggesting an underlying structural defect of the arterial wall. Alpha1-antitrypsin (A1-AT) is a circulating serine proteinase inhibitor of proteolytic enzymes that helps to maintain the integrity of elastic and collagen fibers.
To test the hypothesis that moderate deficiency of A1-AT may be a risk factor for sCAD, 22 cases with sCAD and 113 controls were included in the study.
Patients with sCAD had significantly mean lower levels of A1-AT compared with controls (116.0+/-24.9 versus 141.1+/-31.7 mg/dL; P<0.01). Low levels of A1-AT (<90 mg/dL) were more frequently observed in patients with sCAD compared with controls (27.3% versus 2.7%; P<0.001). A positive correlation between age and plasma levels of A1-AT was found (r=0.22; P<0.01). A1-AT levels were not affected by sex or vascular risk factors, including smoking habit. On multivariate analysis, A1-AT <90 mg/dL was associated with sCAD independently of age, sex, or vascular risk factors (odds ratio, 17.7; 95% confidence interval, 2.9 to 105.6).
Low plasma levels of A1-AT may be a risk factor for sCAD.
在自发性颈动脉夹层（sCAD）患者中已检测到皮肤结缔组织异常，提示动脉壁存在潜在结构缺陷。α1 -抗胰蛋白酶（A1 - AT）是一种循环的丝氨酸蛋白酶抑制剂，可帮助维持弹性纤维和胶原纤维的完整性。
为检验A1 - AT中度缺乏可能是sCAD危险因素这一假说，本研究纳入了22例sCAD患者和113例对照。
与对照组相比，sCAD患者的A1 - AT平均水平显著更低（116.0±24.9对141.1±31.7mg/dL；P<0.01）。与对照组相比，sCAD患者中更频繁观察到低水平的A1 - AT（<90mg/dL）（27.3%对2.7%；P<0.001）。发现年龄与A1 - AT血浆水平呈正相关（r = 0.22；P<0.01）。A1 - AT水平不受性别或血管危险因素（包括吸烟习惯）影响。多因素分析显示，A1 - AT<90mg/dL与sCAD独立相关，与年龄、性别或血管危险因素无关（比值比，17.7；95%置信区间，2.9至105.6）。
A1 - AT血浆水平低可能是sCAD的一个危险因素。
