deVeber G, Monagle P, Chan A, MacGregor D, Curtis R, Lee S, Vegh P, Adams M, Marzinotto V, Leaker M, Massicotte M P, Lillicrap D, Andrew M
Hamilton Civic Hospitals Research Center, McMaster University, Ontario, Canada.
Arch Neurol. 1998 Dec;55(12):1539-43. doi: 10.1001/archneur.55.12.1539.
To our knowledge, the contribution of prothrombotic conditions to cerebral thromboembolism has never been prospectively studied in a large series of pediatric patients.
The Hospital for Sick Children, Toronto, Ontario, established a program in January 1992 to diagnose and treat children (term newborn to 18 years old) with arterial ischemic stroke or sinovenous thrombosis. The routine evaluation for prothrombotic conditions included plasminogen, antithrombin, protein C, free protein S, activated protein C resistance, IgG and IgM anticardiolipin antibody, and lupus anticoagulant. We analyzed samples taken within 2 years of the event. We report results on patients seen from January 1, 1992, to January 1, 1997.
Ninety-two patients (47 males and 45 females) entered the program during the study interval. Patients ranged from newborn to 18 years in age. Arterial ischemic stroke occurred in 78% of patients while sinovenous thrombosis occurred in 22%. All were tested for prothrombotic disorders. One or more abnormal results were present in 35 (38%) of the 92 patients. The majority (21/35) had multiple abnormal test results. The abnormal test results were anticardiolipin antibody (33%), plasminogen (9.5%), activated protein C resistance (9%), protein C (7%), antithrombin (12.5%), lupus anticoagulant (8%), and free protein S (11.5%). Male sex predicted the presence of prothrombotic abnormalities (relative risk, 1.7; 95% confidence interval, 1.2-2.5), but stroke type (relative risk, 0.8; 95% confidence interval, 0.7-1.1), age group, and presence of other risk factors did not predict abnormal testing.
A significant proportion (38%) of children with cerebral thromboembolism had evidence of prothrombotic conditions. In particular, there was a predominance of children with anticardiolipin antibody (33%). These data support a recommendation that children with cerebral thromboembolism be evaluated for prothrombotic disorders.
据我们所知，从未有过针对大量儿科患者前瞻性研究血栓前状态对脑栓塞的影响。
安大略省多伦多市的病童医院于1992年1月设立了一个项目，用于诊断和治疗患有动脉缺血性卒中或静脉窦血栓形成的儿童（足月新生儿至18岁）。对血栓前状态的常规评估包括纤溶酶原、抗凝血酶、蛋白C、游离蛋白S、活化蛋白C抵抗、IgG和IgM抗心磷脂抗体以及狼疮抗凝物。我们分析了事件发生后2年内采集的样本。我们报告了1992年1月1日至1997年1月1日期间就诊患者的结果。
在研究期间，92名患者（47名男性和45名女性）进入了该项目。患者年龄从新生儿到18岁不等。78%的患者发生动脉缺血性卒中，22%的患者发生静脉窦血栓形成。所有患者均接受了血栓前疾病检测。92名患者中有35名（38%）出现一项或多项异常结果。大多数（21/35）患者有多项异常检测结果。异常检测结果包括抗心磷脂抗体（33%）、纤溶酶原（9.5%）、活化蛋白C抵抗（9%）、蛋白C（7%）、抗凝血酶（12.5%）、狼疮抗凝物（8%）和游离蛋白S（11.5%）。男性预示着存在血栓前异常（相对风险，1.7；95%置信区间，1.2 - 2.5），但卒中类型（相对风险，0.8；95%置信区间，0.7 - 1.1）、年龄组以及其他危险因素的存在并不能预示检测异常。
相当比例（38%）的脑栓塞儿童有血栓前状态的证据。特别是，抗心磷脂抗体阳性的儿童占多数（33%）。这些数据支持对脑栓塞儿童进行血栓前疾病评估的建议。
