Zykov V P, Komarova I B, Vasil'ev S A, Ushakova L V, Chuchin M Iu, Netesova E V
Zh Nevrol Psikhiatr Im S S Korsakova. 2009;109(12 Suppl 2):18-24.
Thirty-six patients with stroke, aged from 8 months to 15 years, and 28 control children, aged 1-15 years, were studied. In both groups, the evaluation of anamnesis, neurologic status and genotyping for 11 most common prothrombotic polymorphisms were carried out. Coagulogram tests and measurement of homocysteine were performed before the anticoagulant therapy in the main group. The total frequency of prothrombin gene mutations (G20210A, factor V Leiden, MTHFR C677T and MTRR A66G) was 2.8 times higher in the main group compared to the control one. The most frequent genotypes were 677TT (8.3% of cases) and 66GG (30.6%). In patients with stroke, the homocysteine level exceeded the upper limit of normal age and also was significantly elevated in carriers of abovementioned risk genotypes: 10.29 +/- 1.55 mcmol/l vs 7.33 +/- 0.6 mcmol/l (p = 0.018). The coagulogram revealed disorders of anticoagulant system, including the decrease of protein C activity (22.7% of cases), protein S activity (13.6%) and antithrombin III (12.5%) and the increase of D-dimer level (21% of cases). It has been suggested to screen for common prothrombotic states and measure homocysteine levels in children with ischemic stroke and to lower homocysteine levels by using vitamins B6 and B12' and diet.
对36例年龄在8个月至15岁的中风患者以及28例年龄在1至15岁的对照儿童进行了研究。两组均进行了病史评估、神经系统状况评估以及11种最常见的血栓前多态性基因分型。对主要组的患者在进行抗凝治疗前进行了凝血功能检查和同型半胱氨酸测量。主要组凝血酶原基因突变（G20210A、因子V莱顿、MTHFR C677T和MTRR A66G）的总频率比对照组高2.8倍。最常见的基因型是677TT（占病例的8.3%）和66GG（占30.6%）。中风患者的同型半胱氨酸水平超过正常年龄上限，并且在上述风险基因型携带者中也显著升高：10.29±1.55μmol/L对7.33±0.6μmol/L（p = 0.018）。凝血功能检查显示抗凝系统紊乱，包括蛋白C活性降低（占病例的22.7%）、蛋白S活性降低（13.6%）和抗凝血酶III降低（12.5%）以及D - 二聚体水平升高（占病例的21%）。建议对缺血性中风儿童筛查常见的血栓前状态并测量同型半胱氨酸水平，并通过使用维生素B6和B12以及饮食来降低同型半胱氨酸水平。
