儿童缺血性脑卒中的长期死亡率：一项全国范围内基于登记的队列研究。
Long-Term Mortality in Children With Ischemic Stroke: A Nationwide Register-Based Cohort Study.
机构信息
Division of Children's and Women's Health, Department of Biomedical and Clinical Sciences, Linköping University, Sweden (H.E.K.S., A.W., P.B.).
Neuropediatric Unit, Department of Women's and Children's Health, Karolinska University Hospital (H.E.K.S.), Karolinska Institutet, Stockholm, Sweden.
出版信息
Stroke. 2022 Mar;53(3):837-844. doi: 10.1161/STROKEAHA.121.034797. Epub 2021 Dec 8.
BACKGROUND AND PURPOSE
Ischemic stroke is a common cause of death in adults, however, mortality after pediatric ischemic stroke is not well explored. We investigate long-term and cause-specific mortality in children with ischemic stroke and their first-degree relatives.
METHODS
Through nationwide Swedish registers, we identified 1606 individuals <18 years old with ischemic stroke between 1969 and 2016 and their first-degree relatives (n=5714). Each individual with ischemic stroke was compared with 10 reference individuals (controls) matched for age, sex, and county of residence. Our main analysis examined 1327 children with ischemic stroke still alive 1 week after the event. First-degree relatives to children with ischemic stroke were compared with first-degree relatives to the reference individuals. Using a Cox proportional hazard regression model, the risk of overall and cause-specific mortality was computed in individuals with pediatric ischemic stroke and their first-degree relatives.
RESULTS
The mortality rate in the first 6 months was 40.1 (95% CI, 24.7-55.6) per 1000 person-years compared with 1.1/1000 in controls (95% CI, 0.3-1.9). The overall mortality risk was hazard ratio (HR)=10.8 (95% CI, 8.1-14.3) and remained elevated beyond 20 years (HR=3.9 [95% CI, 2.1-7.1]). Children with ischemic stroke were at increased risk of death from neurological diseases (HR=29.9 [95% CI, 12.7-70.3]), cardiovascular diseases (HR=6.2 [95% CI, 1.8-22.2]), cancers (HR=6.5 [95% CI, 2.6-15.9]) and endocrine, nutritional and metabolic diseases (HR=49.2 [95% CI, 5.7-420.8]). First-degree relatives to children with ischemic stroke had an increased mortality risk (HR=1.21 [95% CI, 1.05-1.39]), with the highest risk among siblings (HR=1.52 [95% CI, 1.09-2.11]) and relatives to individuals with ischemic stroke >28 days of age (HR=1.23 [95% CI, 1.06-1.42]) compared with the relatives of the controls.
CONCLUSIONS
Long-term mortality increased after pediatric ischemic stroke, even 20 years later, with neurological diseases as the most frequent cause of death.
背景与目的
缺血性卒中是成人死亡的常见原因，但儿童缺血性卒中的死亡率尚未得到充分研究。我们调查了患有缺血性卒中的儿童及其一级亲属的长期和特定原因死亡率。
方法
通过全国性的瑞典登记处，我们确定了 1969 年至 2016 年间 1606 名<18 岁的缺血性卒中患者及其一级亲属（n=5714）。每例缺血性卒中患者与 10 名参考个体（对照）进行年龄、性别和居住地匹配。我们的主要分析检查了 1327 名事件发生后 1 周仍存活的儿童缺血性卒中患者。将儿童缺血性卒中患者的一级亲属与参考个体的一级亲属进行比较。使用 Cox 比例风险回归模型，计算了患有儿科缺血性卒中的个体及其一级亲属的总死亡率和特定原因死亡率。
结果
前 6 个月的死亡率为 40.1（95%CI，24.7-55.6）/1000 人年，而对照组为 1.1/1000（95%CI，0.3-1.9）。总体死亡率风险比（HR）=10.8（95%CI，8.1-14.3），20 年后仍居高不下（HR=3.9 [95%CI，2.1-7.1]）。缺血性卒中患儿死于神经系统疾病（HR=29.9 [95%CI，12.7-70.3]）、心血管疾病（HR=6.2 [95%CI，1.8-22.2]）、癌症（HR=6.5 [95%CI，2.6-15.9]）和内分泌、营养代谢疾病（HR=49.2 [95%CI，5.7-420.8]）的风险增加。缺血性卒中患儿的一级亲属死亡率风险增加（HR=1.21 [95%CI，1.05-1.39]），其中兄弟姐妹的风险最高（HR=1.52 [95%CI，1.09-2.11]），年龄>28 天的患儿亲属（HR=1.23 [95%CI，1.06-1.42]）与对照组的亲属相比。
结论
儿科缺血性卒中后长期死亡率增加，甚至 20 年后仍如此，且以神经系统疾病为最常见死因。
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