Department of Pediatrics, Section of Child Neurology, Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado Denver and The Children's Hospital, Aurora, CO 80045-0507, USA.
J Pediatr. 2010 Apr;156(4):651-6. doi: 10.1016/j.jpeds.2009.10.034. Epub 2009 Dec 21.
To test the hypothesis that acute elevations of biomarkers of hypercoagulability and inflammation are common in children with arterial ischemic stroke (AIS), particularly among etiologic subtypes that carry an increased risk of recurrent stroke.
In this prospective/retrospective institutional-based cohort study of acute childhood-onset AIS (n = 50) conducted between 2005 and 2009, D-dimer, factor VIII (FVIII) activity, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were serially evaluated at the time of clinical blood sampling. Patients were classified by stroke subtype as cardioembolic, moyamoya, non-moyamoya arteriopathy, or other.
Both D-dimer and CRP were frequently elevated in acute childhood-onset AIS and exhibited a decreasing trend with time. Acute D-dimer levels were significantly higher in cardioembolic AIS compared with noncardioembolic AIS (median, 2.04 microg/mL [range 0.54-4.54 microg/mL] vs 0.32 microg/mL [0.22-3.18 microg/mL]; P = .002). At an optimal threshold of > or = 0.50 microg/mL, the sensitivity and specificity of D-dimer for cardioembolic subtype were 78% and 79%, respectively.
Our findings identify D-dimer and CRP as candidate biomarkers for etiology and prognosis in childhood-onset AIS. Further studies should investigate the role of these and other biomarkers of hypercoagulability and inflammation in childhood-onset AIS.
检验以下假说，即儿童急性缺血性脑卒中（AIS）患者的高凝和炎症生物标志物水平升高较为常见，尤其是在具有更高卒中复发风险的特定病因亚型中。
本研究为前瞻性/回顾性的基于机构的队列研究，纳入了 2005 年至 2009 年期间发病的 50 例急性儿童期 AIS 患者，在临床采血时连续检测 D-二聚体、因子 VIII（FVIII）活性、C 反应蛋白（CRP）和红细胞沉降率（ESR）。根据卒中亚型将患者分为心源性栓塞、烟雾病、非烟雾病性动脉病变或其他。
儿童急性 AIS 患者中 D-二聚体和 CRP 均频繁升高，并呈随时间降低的趋势。心源性栓塞 AIS 患者的急性 D-二聚体水平显著高于非心源性栓塞 AIS 患者（中位数，2.04μg/mL [范围 0.54-4.54μg/mL] vs 0.32μg/mL [0.22-3.18μg/mL]；P=0.002）。当截断值为＞0.50μg/mL 时，D-二聚体对心源性栓塞亚型的敏感性和特异性分别为 78%和 79%。
本研究发现 D-二聚体和 CRP 可作为儿童 AIS 病因和预后的候选生物标志物。进一步的研究应探究这些以及其他高凝和炎症生物标志物在儿童 AIS 中的作用。
