Lee Janet, Croen Lisa A, Backstrand Kendall H, Yoshida Cathleen K, Henning Louis H, Lindan Camilla, Ferriero Donna M, Fullerton Heather J, Barkovich A J, Wu Yvonne W
Department of Neurology, University of California, San Francisco, CA 94117, USA.
JAMA. 2005 Feb 9;293(6):723-9. doi: 10.1001/jama.293.6.723.
Perinatal arterial ischemic stroke (PAS) is a common cause of hemiplegic cerebral palsy. Risk factors for this condition have not been clearly defined.
To determine maternal and infant characteristics associated with PAS.
DESIGN, SETTING, AND PATIENTS: Case-control study nested within the cohort of all 199,176 infants born from 1997 through 2002 in the Kaiser Permanente Medical Care Program, a managed care organization providing care for more than 3 million residents of northern California. Case patients were confirmed by review of brain imaging and medical records (n = 40). Three controls per case were randomly selected from the study population.
Association of maternal and infant complications with risk of PAS.
The population prevalence of PAS was 20 per 100,000 live births. The majority (85%) of infants with PAS were delivered at term. The following prepartum and intrapartum factors were more common among case than control infants: primiparity (73% vs 44%, P = .002), fetal heart rate abnormality (46% vs 14%, P<.001), emergency cesarean delivery (35% vs 13%, P = .002), chorioamnionitis (27% vs 11%, P = .03), prolonged rupture of membranes (26% vs 7%, P = .002), prolonged second stage of labor (25% vs 4%, P<.001), vacuum extraction (24% vs 11%, P = .04), cord abnormality (22% vs 6%, P = .01), preeclampsia (19% vs 5%, P = .01), and oligohydramnios (14% vs 3%, P = .01). Risk factors independently associated with PAS on multivariate analysis were history of infertility (odds ratio [OR], 7.5; 95% confidence interval [CI], 1.3-45.0), preeclampsia (OR, 5.3; 95% CI, 1.3-22.0), prolonged rupture of membranes (OR, 3.8; 95% CI, 1.1-12.8), and chorioamnionitis (OR, 3.4; 95% CI, 1.1-10.5). The rate of PAS increased dramatically when multiple risk factors were present.
Perinatal arterial ischemic stroke in infants is associated with several independent maternal risk factors. How these complications, along with their potential effects on the placenta and fetus, may play a role in causing perinatal stroke deserves further study.
围产期动脉缺血性卒中（PAS）是偏瘫型脑瘫的常见病因。该疾病的危险因素尚未明确界定。
确定与PAS相关的母婴特征。
设计、研究地点与患者：病例对照研究，嵌套于1997年至2002年在凯撒医疗保健计划中出生的所有199,176名婴儿的队列中，该计划是一家为北加利福尼亚州300多万居民提供医疗服务的管理式医疗组织。通过脑部影像学检查和病历审查确诊病例患者（n = 40）。从研究人群中为每个病例随机选取3名对照。
母婴并发症与PAS风险的关联。
PAS的人群患病率为每10万活产儿20例。大多数（85%）患有PAS的婴儿为足月分娩。以下产前和产时因素在病例组婴儿中比对照组更常见：初产（73%对44%，P = 0.002）、胎儿心率异常（46%对14%，P<0.001）、急诊剖宫产（35%对13%，P = 0.002）、绒毛膜羊膜炎（27%对11%，P = 0.03）、胎膜早破（26%对7%，P = 0.002）、第二产程延长（25%对4%，P<0.001）、真空吸引助产（24%对11%，P = 0.04）、脐带异常（22%对6%，P = 0.01）、先兆子痫（19%对5%，P = 0.01）和羊水过少（14%对3%，P = 0.01）。多因素分析中与PAS独立相关的危险因素为不孕史（比值比[OR]，7.5；95%置信区间[CI]，1.3 - 45.0）、先兆子痫（OR，5.3；95% CI，1.3 - 22.0）、胎膜早破（OR，3.8；95% CI，1.1 - 12.8）和绒毛膜羊膜炎（OR，3.4；95% CI，1.1 - 10.5）。当存在多种危险因素时，PAS的发生率显著增加。
婴儿围产期动脉缺血性卒中与多种独立的母亲危险因素相关。这些并发症及其对胎盘和胎儿的潜在影响如何在围产期卒中的发生中起作用，值得进一步研究。
