Neurologic Institute, Department of Neurology, Columbia University Medical Center, New York, NY, USA.
Int J Stroke. 2014 Jan;9(1):79-87. doi: 10.1111/ijs.12136. Epub 2013 Oct 22.
National organizations recommend cholesterol screening in children to prevent vascular disease in adulthood. There are currently no recommendations for cholesterol and lipoprotein (a) testing in children who experience an arterial ischemic stroke. While dyslipidemia and elevated lipoprotein (a) are associated with ischemic stroke in adults, the role of atherosclerotic risk factors in childhood arterial ischemic stroke is not known. A review of the literature was performed from 1966 to April 2012 to evaluate the association between childhood arterial ischemic stroke and dyslipidemia or elevated lipoprotein (a). Of 239 citations, there were 16 original observational studies in children (with or without neonates) with imaging-confirmed arterial ischemic stroke and data on cholesterol or lipoprotein (a) values. Three pairs of studies reported overlapping subjects, and two were eliminated. Among 14 studies, there were data on cholesterol in 7 and lipoprotein (a) in 10. After stroke, testing was performed at >three-months in nine studies, at ≤three-months in four studies, and not specified in one study. There were five case-control studies: four compared elevated lipoprotein (a) and one compared abnormal cholesterol in children with arterial ischemic stroke to controls. A consistent positive association between elevated lipoprotein (a) and stroke was found [Mantel-Haenszel OR 4·24 (2·94-6·11)]. There was no association in one study on total cholesterol, and a positive association in one study on triglycerides. The literature suggests that elevated lipoprotein (a) may be more likely in children with arterial ischemic stroke than in control children. The absence of confirmatory study on dyslipidemia should be addressed with future research.
国家组织建议对儿童进行胆固醇筛查，以预防成年后的血管疾病。目前，对于经历动脉缺血性卒中的儿童，尚无胆固醇和脂蛋白（a）检测的建议。虽然血脂异常和脂蛋白（a）升高与成人缺血性卒中有关，但动脉粥样硬化危险因素在儿童动脉缺血性卒中中的作用尚不清楚。从 1966 年到 2012 年 4 月，我们对文献进行了回顾，以评估儿童动脉缺血性卒中与血脂异常或脂蛋白（a）升高之间的关系。在 239 篇引用文献中，有 16 项是针对影像学证实的动脉缺血性卒中的儿童（包括新生儿和非新生儿）的原始观察性研究，并有关于胆固醇或脂蛋白（a）值的数据。有三对研究报告了重叠的研究对象，因此排除了其中两项。在 14 项研究中，有 7 项研究提供了胆固醇数据，10 项研究提供了脂蛋白（a）数据。在卒中后，9 项研究在>3 个月时进行了检测，4 项研究在≤3 个月时进行了检测，而有 1 项研究未明确说明。有 5 项病例对照研究：4 项研究比较了动脉缺血性卒中患儿与对照组之间脂蛋白（a）升高的情况，1 项研究比较了胆固醇异常的情况。研究发现，脂蛋白（a）升高与卒中之间存在一致的正相关[Mantel-Haenszel OR 4·24（2·94-6·11）]。有一项关于总胆固醇的研究没有相关性，而有一项关于甘油三酯的研究则存在正相关。文献表明，脂蛋白（a）升高在动脉缺血性卒中患儿中比在对照患儿中更常见。未来的研究应解决关于血脂异常的无确证性研究。
