Grau A J, Buggle F, Steichen-Wiehn C, Heindl S, Banerjee T, Seitz R, Winter R, Forsting M, Werle E, Bode C
Department of Neurology, University of Heidelberg, FRG.
Stroke. 1995 Sep;26(9):1520-6. doi: 10.1161/01.str.26.9.1520.
Currently, recent infection (primarily bacterial infection) is discussed as a risk factor for cerebrovascular ischemia. The aim of this study was to investigate whether the association of ischemic stroke with recent infection is restricted to stroke subtypes and whether recent infection influences the severity of the postischemic deficit; we also aimed to define biochemical pathways linking infection and ischemic stroke.
Analyzing the data of a prospective case-control study, we classified the etiology of cerebrovascular ischemia on the basis of clinical, neuroradiological, sonographical, cardiological, and biochemical data in 159 patients without and in 38 patients with infection within 1 week before ischemia. We assessed the severity of neurological deficits using the Scandinavian Stroke Scale.
In patients with recent infection compared with patients without infection, the neurological deficit on admission was more severe (median of scores, 41 versus 30.5; P < .005), cortical infarcts in the middle cerebral artery territory were more frequent (60% versus 26%; P < .001), the prevalence of extracranial artery stenoses was lower (9% versus 26%; P < .05), and definite or presumed cardioembolic stroke was more frequent (34% versus 19%; P < .05), as was stroke from cervical artery dissection (8% versus 1.3%; P = .05). Serum levels of C-reactive protein were higher in patients with (20.7 +/- 26.8 mg/L) than in those without infection (9.2 +/- 23.7 mg/L; P < .01).
Recent infection may be associated with a more severe postischemic deficit and with an increased risk of stroke from cardioembolic origin and from cervical arterial dissection.
目前，近期感染（主要是细菌感染）被认为是脑血管缺血的一个危险因素。本研究的目的是调查缺血性卒中与近期感染之间的关联是否仅限于卒中亚型，以及近期感染是否会影响缺血后神经功能缺损的严重程度；我们还旨在确定连接感染与缺血性卒中的生化途径。
分析一项前瞻性病例对照研究的数据，我们根据临床、神经放射学、超声、心脏病学和生化数据，对159例在缺血前1周内未感染的患者和38例感染患者的脑血管缺血病因进行分类。我们使用斯堪的纳维亚卒中量表评估神经功能缺损的严重程度。
与未感染患者相比，近期感染患者入院时的神经功能缺损更严重（评分中位数分别为41和30.5；P <.005），大脑中动脉区域的皮质梗死更常见（60% 对26%；P <.001），颅外动脉狭窄的患病率更低（9% 对26%；P <.05），明确或推测的心源性栓塞性卒中更常见（34% 对19%；P <.05），颈动脉夹层所致卒中也是如此（8% 对1.3%；P =.05）。感染患者的血清C反应蛋白水平（20.7±26.8 mg/L）高于未感染患者（9.2±23.7 mg/L；P <.01）。
近期感染可能与更严重的缺血后神经功能缺损以及心源性栓塞和颈动脉夹层所致卒中风险增加有关。
