Prothrombotic disorders in infants and children with cerebral thromboembolism
Prothrombotic disorders in infants and children with cerebral thromboembolism
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DOI：
10.1001/archneur.55.12.1539
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发表时间：
1998-12-01
影响因子：
--
通讯作者：
Andrew, M
中科院分区：
文献类型：
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作者：
deVeber, G;Monagle, P;Andrew, M
背景资料：据我们所知，血栓形成前的条件，脑血栓栓塞的贡献从来没有被前瞻性地研究了一个大系列的儿科patients.Methods：医院为患病儿童，多伦多，安大略，在1992年1月建立了一个程序，诊断和治疗儿童（足月新生儿至18岁）动脉缺血性中风或窦静脉血栓形成。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抗心磷脂抗体和狼疮抗凝剂。我们分析了事件发生后两年内采集的样本。我们报告了1992年1月1日至1997年1月1日期间观察的患者的结果。结果：92例患者（47例男性和45例女性）在研究期间进入该计划。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%的患者发生窦静脉血栓形成。所有患者均接受了血栓前疾病检查。92例患者中有35例（38%）出现一个或多个异常结果。大多数（21/34）有多个异常检测结果。异常结果依次为抗心磷脂抗体（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%）、游离蛋白S（11.5%）。男性可预测血栓前异常的存在（相对危险度，1.7; 95%置信区间，1.2-2.5），但卒中类型（相对危险度，0.8; 95%可信区间，0.7-1.1）、年龄组和其他危险因素的存在并不能预测异常检测。有显著比例（38%）的脑血栓栓塞儿童有血栓前状态的证据。特别是，有抗心磷脂抗体的儿童占主导地位（33%）。这些数据支持一项建议，即对脑血栓栓塞的儿童进行血栓前疾病的评估。
Background: To our knowledge, the contribution of prothrombotic conditions to cerebral thromboembolism has never been prospectively studied in a large series of pediatric patients.Methods: 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.Results: 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 (21/34) 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.Conclusions: 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.