Piñol-Ripoll G, de la Puerta I, Santos S, Purroy F, Mostacero E
Division of Neurology, Hospital Clínico Universitario de Zaragoza, Zaragoza, Spain.
Cerebrovasc Dis. 2008;26(4):339-47. doi: 10.1159/000151636. Epub 2008 Aug 27.
Acute and chronic infections may play a role in promoting complications of atherosclerotic disease. We evaluated the importance of acute infections and chronic bronchitis (CB; as a chronic inflammatory state) in several subtypes of ischemic stroke, and we investigated whether the influenza vaccination was independently associated with a reduced likelihood of stroke.
A case-control study was performed on 393 consecutive ischemic stroke patients and 393 control subjects matched for age, sex and time of year. Data were collected by a structured interview that assessed risk factors, acute infections within the preceding 2 months, CB and whether they had received the influenza vaccination.
Infections within the 2 months before stroke onset and CB were more common among patients than control subjects [23.3 vs. 16.3% (p = 0.014) and 17.2 vs. 8.5% (p = 0.001), respectively]. After adjustment for traditional risk factors, the risk of stroke was increased in the subjects with CB (OR = 1.83, 95% CI = 1.35-2.48, p = 0.016), but not with acute infection (OR = 1.32, 95% CI = 0.98-1.78, p = 0.16). Acute infections and CB increased the risk of ischemic events in all age groups; this reached significance for patients older than 60 years. The profile of vascular risk factors was similar in patients with and without previous infections. The influenza vaccination did not prevent ischemic stroke, and it did not reduce the rate of acute previous infections in stroke patients.
CB and infections over the previous 2 months predicted the risk of ischemic stroke. The influenza vaccination was not associated with a reduction in the incidence of stroke in our group of patients.
急慢性感染可能在促进动脉粥样硬化疾病并发症方面发挥作用。我们评估了急性感染和慢性支气管炎（CB；作为一种慢性炎症状态）在几种缺血性卒中亚型中的重要性，并研究了流感疫苗接种是否与卒中可能性降低独立相关。
对393例连续性缺血性卒中患者和393例年龄、性别及季节相匹配的对照者进行病例对照研究。通过结构化访谈收集数据，该访谈评估了危险因素、前2个月内的急性感染、CB以及他们是否接种了流感疫苗。
卒中发作前2个月内的感染和CB在患者中比对照者更常见[分别为23.3%对16.3%（p = 0.014）和17.2%对8.5%（p = 0.001）]。在调整传统危险因素后，CB患者发生卒中的风险增加（OR = 1.83，95% CI = 1.35 - 2.48，p = 0.016），但急性感染患者未增加（OR = 1.32，95% CI = 0.98 - 1.78，p = 0.16）。急性感染和CB增加了所有年龄组缺血性事件的风险；这在60岁以上患者中具有统计学意义。有或无既往感染患者的血管危险因素特征相似。流感疫苗接种不能预防缺血性卒中，也未降低卒中患者既往急性感染的发生率。
CB和前2个月内的感染可预测缺血性卒中风险。在我们的患者组中，流感疫苗接种与卒中发病率降低无关。
