Symptomatic ischemic stroke in full-term neonates -: Role of acquired and genetic prothrombotic risk factors
Symptomatic ischemic stroke in full-term neonates -: Role of acquired and genetic prothrombotic risk factors
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DOI：
10.1161/01.str.31.10.2437
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发表时间：
2000-10-01
期刊：
影响因子：
8.3
通讯作者：
Nowak-Göttl, U
中科院分区：
文献类型：
--
作者：
Günther, G;Junker, R;Nowak-Göttl, U
背景和目的：本多中心病例对照研究是前瞻性设计的，旨在评估单一和联合凝血因子异常对足月新生儿症状性缺血性卒中发病的影响程度。方法：脂蛋白（Lp）（a）;因子V（FV）G1691 A突变;凝血酶原（PT）G20210 A变异;亚甲基四氢叶酸还原酶（MTHFR）T677 T基因型;抗凝血酶;蛋白C、蛋白S;对91例新生儿脑卒中患者和182例年龄和性别匹配的健康对照者进行了研究（68.1%）至少有1个血栓前危险因素，而对照组为44个（24.2%）（比值比[OR]/95%置信区间[CI]，6.70/3.84至11.67）。Lp（a）水平升高20例患者和10例对照组中检测到30 mg/dL（OR/95% CI，4.84/2.16至10.86）; 17例患者和10例对照中存在FV G1691 A（OR/95% CI，3.95/1.72至9.0）;在4例患者和4例对照中检测到PT G20210 A变异体MTHFR TT 677基因型在15例患儿和20例对照组中检出（OR/95% CI为1.59/0.77 ~ 3.29），6例患儿存在蛋白C I型缺陷。在研究的新生儿患者中既没有发现抗凝血酶缺乏症，也没有发现蛋白S缺乏症。获得性IgG ACA 3例。额外的触发因素，即窒息，败血症，母亲糖尿病，围产期获得性肾静脉血栓形成，在54.0%的patients. Conclusions，除了获得性触发因素，这里提出的数据表明，遗传性血栓前危险因素在有症状的新生儿中风中发挥作用。
Background and Purpose-The present multicenter case-control study was prospectively designed to assess the extent to which single and combined clotting factor abnormalities influence the onset of symptomatic ischemic stroke in full-term neonates,Methods-Lipoprotein (Lp)(a); the factor V (FV) G1691A mutation; the prothrombin (PT) G20210A variant; the methylenetetrahydrofolate reductase (MTHFR) T677T genotype; antithrombin; protein C, protein S; and anticardiolipin antibodies (ACAs) were investigated in 91 consecutively recruited neonatal stroke patients and 182 age- and sex-matched healthy controls.Results-Sixty-two of 91 stroke patients (68.1%) had at least 1 prothrombotic risk factor compared with 44 control subjects (24.2%) (odds ratio [OR]/95% confidence interval [CI], 6.70/3.84 to 11.67). An increased Lp(a) level (>30 mg/dL) was found in 20 patients and 10 controls (OR/95% CI, 4.84/2.16 to 10.86); FV G1691A was present in 17 patients and 10 controls (OR/95% CI, 3.95/1.72 to 9.0); the PT G20210A variant was detected in 4 patients and 4 controls (OR/95% CI, 2.04/0.49 to 8.3); the MTHFR TT677 genotype was found in 15 patients and 20 controls (OR/95% CI, 1.59/0.77 to 3.29); and protein C type I deficiency was found in 6 neonates. Neither antithrombin deficiency nor protein S deficiency was found in the neonatal patients studied. Acquired IgG ACAs were found in 3 cases. Additional triggering factors, ie, asphyxia, septicemia, maternal diabetes, and perinatally acquired renal venous thrombosis, were reported in 54.0% of patients.Conclusions-Besides acquired triggering factors, the data presented here suggest that genetic prothrombotic risk factors play a role in symptomatic neonatal stroke.