Division of Hematology, Departments of Pediatrics and Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
J Pediatr. 2013 May;162(5):1041-6.e1. doi: 10.1016/j.jpeds.2012.11.035. Epub 2012 Dec 20.
To assess whether acute findings of cerebral arteriopathy, large infarct, and acutely elevated plasma D-dimer levels are independently prognostic of poor long-term neurologic outcome as measured at ≥ 1 year post-event in children with arterial ischemic stroke (AIS).
Sixty-one patients with childhood-onset (ie, >28 days of life) AIS were enrolled in a single-institution cohort study at Children's Hospital Colorado between February 2006 and June 2011. Data on demographic and diagnostic characteristics, antithrombotic treatments, and outcomes were systematically collected.
Cerebral arteriopathy and D-dimer levels >500 ng/mL (a measure of coagulation activation) were identified acutely in 41% and 31% of the cohort, respectively. Anticoagulation was administered in the acute period post-event in 40% of the children, in the subacute period in 43%, and in the chronic period in 28%. When not receiving anticoagulation, patients were routinely treated with aspirin 2-5 mg/kg once daily for a minimum of 1 year. Death, major bleeding (including intracranial hemorrhage), and recurrent AIS were infrequent. The Pediatric Stroke Outcome Measure at 1 year demonstrated poor outcome in 54% of the children. Acute cerebral arteriopathy and elevated D-dimer level were identified as putative prognostic factors for poor outcome; after adjustment for D-dimer, arteriopathy was an independent prognostic indicator (OR, 19.0; 95% CI, 1.6-229.8; P = .02).
Arteriopathy and coagulation activation are highly prevalent in the acute period of childhood AIS. Although recurrent AIS and intracranial hemorrhage were infrequent in our cohort, one-half of children experienced a poor neurologic outcome at 1 year, the risk of which was increased by acute arteriopathy. Substantiation of these findings in multi-institutional cohort studies is warranted, toward risk stratification in childhood-onset AIS.
评估儿童动脉缺血性脑卒中（AIS）患者在事件发生后≥1 年时，大脑动脉病变、大梗死和急性血浆 D-二聚体水平升高这些急性发现是否可独立预测预后不良的长期神经结局。
2006 年 2 月至 2011 年 6 月，科罗拉多州儿童医院的单中心队列研究纳入了 61 例儿童期（即>28 天）AIS 患者。系统性收集人口统计学和诊断特征、抗血栓治疗和结局数据。
该队列中分别有 41%和 31%的患者在急性发作时发现动脉病变和 D-二聚体水平>500ng/ml（凝血激活的一种衡量指标）。40%的患儿在事件后急性期接受抗凝治疗，43%在亚急性期，28%在慢性期。如果不接受抗凝治疗，患儿通常会接受 2-5mg/kg 阿司匹林，每日 1 次，至少持续 1 年。死亡、大出血（包括颅内出血）和复发性 AIS 很少发生。1 年时的小儿脑卒中结局评估显示，54%的患儿预后不良。急性大脑动脉病变和升高的 D-二聚体水平被确定为不良预后的推测性预后因素；在校正 D-二聚体后，动脉病变是独立的预后指标（OR，19.0；95%CI，1.6-229.8；P=.02）。
儿童 AIS 急性期动脉病变和凝血激活很常见。虽然本队列中复发性 AIS 和颅内出血少见，但一半的患儿在 1 年时神经结局不良，急性动脉病变会增加这种风险。有必要在多中心队列研究中证实这些发现，以便对儿童期 AIS 进行风险分层。
