Grau A J, Buggle F, Becher H, Zimmermann E, Spiel M, Fent T, Maiwald M, Werle E, Zorn M, Hengel H, Hacke W
Department of Neurology, University of Heidelberg, Germany.
Neurology. 1998 Jan;50(1):196-203. doi: 10.1212/wnl.50.1.196.
We performed a case-control study to investigate the role of recent infection as stroke risk factor and to identify pathogenetic pathways linking infection and stroke. We examined 166 consecutive patients with acute cerebrovascular ischemia and 166 patients hospitalized for nonvascular and noninflammatory neurologic diseases. Control subjects were individually matched to patients for sex, age, and season of admission. We assessed special biochemical parameters in subgroups of stroke patients with and without recent infection (n = 21) who were similar with respect to demographic and clinical parameters. Infection within the preceding week was a risk factor for cerebrovascular ischemia in univariate (odds ratio [OR] 3.1; 95% confidence interval (CI), 1.57 to 6.1) and age-adjusted multiple logistic regression analysis (OR 2.9; 95% CI, 1.31 to 6.4). The OR of recent infection and age were inversely related. Both bacterial and viral infection contributed to increased risk. Infection elevated the risk for cardioembolism and tended to increase the risk for arterioarterial embolism. Stroke patients with and without preceding infection were not different with respect to factor VII and factor VIII activity, fibrin monomer, fibrin D-dimer, von Willebrand factor, C4b-binding protein, protein S, anticardiolipin antibodies, interleukin-1 receptor antagonist, soluble tumor necrosis factor-alpha receptor, interleukin-6, interleukin-8, and neopterin. In conclusion, recent infection is an independent risk factor for acute cerebrovascular ischemia. Its role appears to be more important in younger age groups. The pathogenetic linkage between infection and stroke is still insufficiently understood.
我们进行了一项病例对照研究，以调查近期感染作为中风危险因素的作用，并确定将感染与中风联系起来的发病机制途径。我们检查了166例连续的急性脑血管缺血患者和166例因非血管性和非炎性神经疾病住院的患者。对照受试者在性别、年龄和入院季节方面与患者进行了个体匹配。我们评估了近期有感染和无感染的中风患者亚组（n = 21）中的特殊生化参数，这些亚组在人口统计学和临床参数方面相似。在前一周内发生的感染在单因素（比值比[OR] 3.1；95%置信区间[CI]，1.57至6.1）和年龄调整的多因素逻辑回归分析（OR 2.9；95% CI，1.31至6.4）中是脑血管缺血的危险因素。近期感染的OR与年龄呈负相关。细菌和病毒感染均导致风险增加。感染增加了心源性栓塞的风险，并倾向于增加动脉到动脉栓塞的风险。有和无前驱感染的中风患者在因子VII和因子VIII活性、纤维蛋白单体、纤维蛋白D-二聚体、血管性血友病因子、C4b结合蛋白、蛋白S、抗心磷脂抗体、白细胞介素-1受体拮抗剂、可溶性肿瘤坏死因子-α受体、白细胞介素-6、白细胞介素-8和新蝶呤方面没有差异。总之，近期感染是急性脑血管缺血的独立危险因素。其作用在较年轻年龄组中似乎更为重要。感染与中风之间的发病机制联系仍未得到充分理解。
