Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine.
Clin Infect Dis. 2014 Jan;58(1):61-8. doi: 10.1093/cid/cit659. Epub 2013 Oct 2.
There is good evidence that respiratory and other infections that cause systemic inflammation can trigger strokes; however, the role of specific infections is unclear. Case reports have highlighted chickenpox as a possible risk factor for arterial ischemic stroke, particularly in children, but rigorous studies are needed to determine and quantify any increased risk.
We used anonymized electronic health records totaling >100 million person-years of observation from 4 UK primary care databases to identify individuals who had documented clinical chickenpox and a stroke or transient ischemic attack (TIA). Self-controlled case series methods were used to quantify any increased risk of first stroke or TIA in the 0-6 and 7-12 months following chickenpox compared to other observed time periods. We analyzed data within each database, and performed meta-analyses to obtain summary age-adjusted incidence ratios (IRs) separately for adults and children.
Five hundred sixty eligible individuals (including 60 children) were identified who experienced chickenpox and a stroke or TIA during follow-up. Among children, there was a 4-fold increased risk of stroke in the 0-6 months after chickenpox (summary IR = 4.07; 95% confidence interval [CI], 1.96-8.45; I(2) = 0%). Among adults, there was a less marked increased risk with moderate between-database heterogeneity (random-effects summary IR = 2.13; 95% CI, 1.05-4.36; I(2) = 51%). There was no significant increased risk of stroke in the 7-12 months after chickenpox in children or adults, nor was there evidence of increased risk of TIA in either time period.
Our study provides new evidence that children who experience chickenpox are at increased risk of stroke in the subsequent 6 months.
有充分证据表明，引发全身炎症的呼吸道感染和其他感染可能会引发中风；然而，具体感染的作用尚不清楚。病例报告强调了水痘可能是动脉缺血性中风的一个潜在危险因素，尤其是在儿童中，但需要严格的研究来确定和量化任何增加的风险。
我们使用来自 4 个英国初级保健数据库的超过 1 亿人年的匿名电子健康记录，来识别记录有临床水痘和中风或短暂性脑缺血发作（TIA）的个体。采用自我对照病例系列方法，来量化与其他观察时间段相比，水痘后 0-6 个月和 7-12 个月内首次中风或 TIA 的风险增加情况。我们在每个数据库内分析数据，并进行荟萃分析，分别为成人和儿童获得年龄调整的综合发病率比（IR）。
在随访期间，有 560 名符合条件的个体（包括 60 名儿童）被识别出经历了水痘和中风或 TIA。在儿童中，水痘后 0-6 个月中风的风险增加了 4 倍（综合 IR = 4.07；95%置信区间 [CI]，1.96-8.45；I² = 0%）。在成人中，风险增加幅度较小，且数据库间存在中度异质性（随机效应综合 IR = 2.13；95%CI，1.05-4.36；I² = 51%）。在儿童或成人中，水痘后 7-12 个月内没有发现中风风险显著增加，也没有证据表明在任何时间段内 TIA 风险增加。
我们的研究提供了新的证据，表明患有水痘的儿童在随后的 6 个月内中风风险增加。
