Inflammatory Biomarkers in Childhood Arterial Ischemic Stroke: Correlates of Stroke Cause and Recurrence.
Inflammatory Biomarkers in Childhood Arterial Ischemic Stroke: Correlates of Stroke Cause and Recurrence.
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DOI：
10.1161/strokeaha.116.013719
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发表时间：
2016-09
期刊：
影响因子：
8.3
通讯作者：
VIPS Investigators
中科院分区：
文献类型：
--
作者：
Fullerton HJ;deVeber GA;Hills NK;Dowling MM;Fox CK;Mackay MT;Kirton A;Yager JY;Bernard TJ;Hod EA;Wintermark M;Elkind MS;VIPS Investigators
在患有动脉缺血性卒中（AIS）的儿童中，动脉病变的复发风险最高。我们假设动脉病变进展是一个炎症过程，炎症生物标志物可以预测AIS复发。在一项儿童AIS的国际研究中，我们选择了三种最常见的儿童AIS病因之一的病例：明确的动脉性（N=103），心源性（N=55）或特发性（N=78）。我们检测了血清超敏C反应蛋白（hsCRP）、血清淀粉样蛋白A（SAA）、髓过氧化物酶（MPO）和肿瘤坏死因子α（TNF-α）的浓度。我们使用线性回归来比较亚型之间的分析物浓度，并使用考克斯比例风险模型来确定复发性AIS的预测因子。首次卒中时的中位年龄为8.2岁（IQR 3.6，14.3）;在卒中后中位5.5天（IQR 3，10天）采集血清样本。在调整模型（包括年龄、梗死体积和样本采集时间）后，以特发性作为参考，心源性栓塞（而非动脉病）组的hsCRP和MPO浓度较高，而心源性栓塞和动脉病组的SAA均较高。在动脉病变组（而非心源性栓塞组），较高的hsCRP和SAA可预测AIS复发。与动脉病变稳定或改善的儿童相比，进行性动脉病变的儿童在随访成像中有更高的复发率，并且有更高的hsCRP和SAA的趋势。在患有AIS的儿童中，特异性炎症生物标志物与病因相关，并且在动脉病组中与卒中复发风险相关。针对炎症的干预措施应考虑用于儿科卒中二级预防试验。
Among children with arterial ischemic stroke (AIS), those with arteriopathy have the highest recurrence risk. We hypothesized that arteriopathy progression is an inflammatory process, and that inflammatory biomarkers would predict recurrent AIS. In an international study of childhood AIS, we selected cases classified into one of the three most common childhood AIS etiologies: definite arteriopathic (N=103), cardioembolic (N=55), or idiopathic (N=78). We measured serum concentrations of high sensitivity C-reactive protein (hsCRP), serum amyloid A (SAA), myeloperoxidase (MPO), and tumor necrosis factor alpha (TNF-α). We used linear regression to compare analyte concentrations across the subtypes, and Cox proportional hazards models to determine predictors of recurrent AIS. Median age at index stroke was 8.2 years (IQR 3.6, 14.3); serum samples were collected at median 5.5 days post-stroke (IQR 3, 10 days). In adjusted models (including age, infarct volume, and time to sample collection) with idiopathic as the reference, the cardioembolic (but not arteriopathic) group had higher concentrations of hsCRP and MPO, while both cardioembolic and arteriopathic groups had higher SAA. In the arteriopathic (but not cardioembolic) group, higher hsCRP and SAA predicted recurrent AIS. Children with progressive arteriopathies on follow-up imaging had higher recurrence rates, and a trend towards higher hsCRP and SAA, compared to children with stable or improved arteriopathies. Among children with AIS, specific inflammatory biomarkers correlate with etiology and—in the arteriopathy group—risk of stroke recurrence. Interventions targeting inflammation should be considered for pediatric secondary stroke prevention trials.