Thrombosis Center, Department of Biotecnologie Cellulari ed Ematologia, University Sapienza, Rome, Italy.
Thromb Res. 2011 Feb;127(2):85-90. doi: 10.1016/j.thromres.2010.11.013. Epub 2010 Dec 18.
Despite extensive clinical and laboratory investigations, the etiology of ischemic stroke remains unknown in approximately one third of patients.
Thirty-four consecutive patients less than 40 years old (Males 13, Females 21, mean age 26.6 years, range 2-39) with documented ischemic stroke underwent, one year after the acute event, laboratory evaluation of antithrombin, protein C, free and total protein S, activated protein C resistance, fibrinogen, factor VII:C, homocysteine levels and antiphospholipid antibodies (APA). Moreover, prevalence of F5 R506Q, F2 G2021A and homozygosis for thermolabile variant C677T of the methylenetetrahydrofolate reductase (MTHFR) were also evaluated and compared to the results obtained in 120 normal controls.
Antithrombin and protein C levels resulted normal in all cases. One patient (2.9%) showed free protein S deficiency and 3 patients (8.8%) had activated protein C resistance. Homocysteine levels above 15 μmol/L were found in one patient (2.9%). APA were found in 21 patients (61.7%) and in only 2 out of 120 (1.66%) controls (OR=95.31; 95% C.I.: 18.22-667.81). The multivariate analysis selected that the presence of APA was significantly associated with an increased risk of stroke (OR=156.60; 95% C.I.: 25.99-943.47) in this cohort of patients. The combination between APA and cardiovascular risk factors determined a risk of 29-fold (OR=29.31; 95% CI: 3.28-261.69).
Our data suggest that the presence of APA is associated with an increased risk of idiopathic ischemic stroke in young patients. Furthermore, also the combination of APA and cardiovascular risk factors is significantly associated with development of idiopathic ischemic stroke.
尽管进行了广泛的临床和实验室检查，仍有约三分之一的缺血性脑卒中患者病因不明。
34 例年龄小于 40 岁（男性 13 例，女性 21 例，平均年龄 26.6 岁，范围 2-39 岁）的确诊缺血性脑卒中患者，在急性事件发生一年后，进行抗凝血酶、蛋白 C、游离蛋白 S、总蛋白 S、活化蛋白 C 抵抗、纤维蛋白原、因子 VII:C、同型半胱氨酸水平和抗磷脂抗体（APA）的实验室评估。此外，还评估并比较了 34 例患者中 F5 R506Q、F2 G2021A 和亚甲基四氢叶酸还原酶（MTHFR）热不稳定变异型 C677T 的纯合性的发生率，并与 120 例正常对照的结果进行了比较。
所有患者的抗凝血酶和蛋白 C 水平均正常。1 例患者（2.9%）存在游离蛋白 S 缺乏，3 例患者（8.8%）存在活化蛋白 C 抵抗。1 例患者（2.9%）同型半胱氨酸水平高于 15μmol/L。21 例患者（61.7%）存在 APA，而 120 例对照中仅 2 例（1.66%）存在 APA（OR=95.31；95%CI：18.22-667.81）。多变量分析表明，在该患者队列中，APA 的存在与中风风险增加显著相关（OR=156.60；95%CI：25.99-943.47）。APA 与心血管危险因素的联合作用使风险增加了 29 倍（OR=29.31；95%CI：3.28-261.69）。
我们的数据表明，APA 的存在与年轻患者特发性缺血性脑卒中的风险增加相关。此外，APA 与心血管危险因素的联合作用与特发性缺血性脑卒中的发生显著相关。
