Grabowski Eric F, Buonanno Ferdinando S, Krishnamoorthy Kalpathy
Department of Pediatrics (Hematology/Oncology), Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
Semin Perinatol. 2007 Aug;31(4):243-9. doi: 10.1053/j.semperi.2007.06.001.
The ischemia in children affected by perinatal stroke has long been thought to be driven by nonhematologic maternal and perinatal events. New information from clinical studies, however, tells us that plasma-phase risk factors, such as factor V Leiden, elevated lipoprotein (a), and mutations in MTHFR, may be important in the pathogenesis of perinatal stroke, if not always in the risk of recurrence. With regard to stroke recurrence, this risk is only about 2% according to the largest follow-up study to date, and certainly less than 5%. Nonetheless, when strokes do recur, they tend to be associated with the presence of plasma-phase risk factors in the affected child, suggesting that a small percentage of children with a first perinatal stroke may benefit from anticoagulation therapy, both to prevent stroke recurrence as well as occurence of a second, non-CNS thrombotic event. Counselling of parents with regard to subsequent pregnancies should always include medical management of systemic maternal disorders, such as diabetes, persistently elevated antiphospholipid antibodies, and inherited maternal hypercoagulability states.
长期以来，人们一直认为围产期卒中患儿的局部缺血是由非血液学的母体及围产期事件所导致。然而，临床研究的新信息告诉我们，血浆期危险因素，如凝血因子V莱顿突变、脂蛋白(a)升高以及亚甲基四氢叶酸还原酶(MTHFR)突变，即便并非总是与复发风险相关，但在围产期卒中的发病机制中可能起着重要作用。关于卒中复发，根据迄今为止最大规模的随访研究，这种风险仅约为2%，肯定低于5%。尽管如此，当卒中确实复发时，往往与患病儿童存在血浆期危险因素有关，这表明一小部分首次发生围产期卒中的儿童可能会从抗凝治疗中获益，既能预防卒中复发，也能预防第二次非中枢神经系统血栓形成事件的发生。在为有后续妊娠计划的父母提供咨询时，应始终包括对母体全身性疾病的医学管理，如糖尿病、持续升高的抗磷脂抗体以及遗传性母体高凝状态。
