Go Alan S, Reed Guy L, Hylek Elaine M, Phillips Kathleen A, Liu Lin, Henault Lori E, Selby Joe V, Singer Daniel E
Division of Research, Kaiser Permanente of Northern California, Oakland, CA, USA.
J Thromb Thrombolysis. 2003 Feb;15(1):41-6. doi: 10.1023/a:1026192301848.
Atrial fibrillation is a major cause of cardioembolic stroke. Since atrial and venous pressures are similar, genetic variants that promote venous thromboembolism may increase the risk of atrial thrombi and subsequent stroke in atrial fibrillation.
We conducted a nested case-control study of the association between the presence of factor V Leiden polymorphism and incident ischemic stroke within a prospective cohort of 13,559 adult patients with diagnosed nonvalvular atrial fibrillation between July 1, 1996 and December 31, 1997. Incident cases with ischemic strokes were identified through August 31, 1999 and matching stroke-free controls were enrolled.
One hundred thirty-seven case patients with incident stroke and 214 controls were enrolled. Cases were older, more likely to be women, and more likely to have a prior stroke, heart failure, hypertension, diabetes, and coronary disease. The factor V Leiden polymorphism was present in 5.8% of cases and 3.7% of controls (P = 0.36). Among non-anticoagulated patients, 7/96 (7.3%) case patients and 3/81 (3.6%) control subjects were heterozygous for factor V Leiden (Odds Ratio 2.1 [95% CI: 0.5-8.4]). Adjustment for known stroke risk factors did not significantly change the observed association in non-anticoagulated patients (adjusted OR 1.9 [0.5-8.0]).
Within a large nested case-control sample of patients with atrial fibrillation, factor V Leiden was not significantly associated with risk of stroke. However, given the suggestive nature of our findings, further study in even larger numbers of patients is needed to clarify the impact of factor V Leiden on stroke risk in atrial fibrillation.
心房颤动是心源性栓塞性卒中的主要病因。由于心房压和静脉压相似，促进静脉血栓栓塞的基因变异可能会增加心房颤动患者发生心房血栓及随后卒中的风险。
我们在1996年7月1日至1997年12月31日期间确诊的13559例非瓣膜性心房颤动成年患者的前瞻性队列中，进行了一项关于因子V莱顿多态性与缺血性卒中发生之间关联的巢式病例对照研究。通过1999年8月31日确定了缺血性卒中的发病病例，并纳入了匹配的无卒中对照。
共纳入137例发生卒中的病例患者和214例对照。病例患者年龄更大，女性比例更高，更有可能有既往卒中、心力衰竭、高血压、糖尿病和冠心病。因子V莱顿多态性在5.8%的病例患者和3.7%的对照中存在（P = 0.36）。在未接受抗凝治疗的患者中，96例病例患者中有7例（7.3%）和81例对照中有3例（3.6%）为因子V莱顿杂合子（比值比2.1 [95%可信区间：0.5 - 8.4]）。对已知的卒中危险因素进行校正后，未接受抗凝治疗患者中观察到的关联无显著变化（校正后的比值比1.9 [0.5 - 8.0]）。
在一个大型的心房颤动患者巢式病例对照样本中，因子V莱顿与卒中风险无显著关联。然而，鉴于我们研究结果的提示性质，需要在更多患者中进行进一步研究，以阐明因子V莱顿对心房颤动患者卒中风险的影响。
