Ganesan Vijeya, Prengler Mara, Wade Angela, Kirkham Fenella J
Neurosciences Unit, Institute of Child Health, University College London, London, United Kingdom.
Circulation. 2006 Nov 14;114(20):2170-7. doi: 10.1161/CIRCULATIONAHA.105.583690. Epub 2006 Oct 30.
Data on rates and risk factors for clinical and radiological recurrence of childhood arterial ischemic stroke (AIS) might inform secondary prevention strategies.
Consecutive Great Ormond Street Hospital patients with first AIS were identified retrospectively (1978-1990) and prospectively (1990-2000). Patients underwent repeat neuroimaging at the time of clinical recurrence or, if asymptomatic, at least 1 year after AIS. Cox and logistic regression analyses were used to explore the relationships between risk factors and clinical and radiological recurrence, respectively. A total of 212 patients were identified, of whom 97 had another prior diagnosis. Seventy-nine children had a clinical recurrence (29 strokes, 46 transient ischemic attacks [TIAs], 4 deaths with reinfarction 1 day to 11.5 years (median 267 days) later); after 5 years, 59% (95% confidence interval, 51% to 67%) were recurrence free. Moyamoya on angiography and low birth weight were independently associated with clinical recurrence in the whole group. Genetic thrombophilia was associated with clinical recurrence in previously healthy patients, independent of the presence of moyamoya. Sixty of 179 patients who had repeat neuroimaging had radiological reinfarction, which was clinically silent in 20. Previous TIA, bilateral infarction, prior diagnosis (specifically immunodeficiency), and leukocytosis were independently associated with reinfarction. Previous TIA and leukocytosis were also independently associated with clinically silent reinfarction.
Clinical and radiological recurrence are common after childhood AIS. The risk of clinical recurrence is increased in children with moyamoya and, in previously healthy patients, in those with genetic thrombophilia. Preexisting pathology, including immunodeficiency, and persistent leukocytosis are risk factors for radiological recurrence, which suggests a potential role for chronic infection.
儿童动脉缺血性卒中（AIS）临床及影像学复发率和危险因素的数据可能有助于二级预防策略的制定。
对大奥蒙德街医院连续收治的首次发生AIS的患者进行回顾性（1978 - 1990年）和前瞻性（1990 - 2000年）研究。患者在临床复发时或无症状时，于AIS发生后至少1年接受重复神经影像学检查。分别采用Cox回归和逻辑回归分析来探讨危险因素与临床及影像学复发之间的关系。共确定了212例患者，其中97例有其他既往诊断。79例儿童出现临床复发（29次卒中，46次短暂性脑缺血发作[TIA]，4例死亡且1天至11.5年（中位267天）后再发梗死）；5年后，59%（95%置信区间，51%至67%）无复发。血管造影显示烟雾病和低出生体重与全组临床复发独立相关。遗传性易栓症与既往健康患者的临床复发相关，与烟雾病的存在无关。179例接受重复神经影像学检查的患者中有60例发生影像学再梗死，其中20例临床上无症状。既往TIA、双侧梗死、既往诊断（特别是免疫缺陷）和白细胞增多与再梗死独立相关。既往TIA和白细胞增多也与临床上无症状的再梗死独立相关。
儿童AIS后临床及影像学复发很常见。烟雾病患儿以及既往健康且患有遗传性易栓症的患者临床复发风险增加。包括免疫缺陷在内的既往病变和持续性白细胞增多是影像学复发的危险因素，这提示慢性感染可能起作用。
