Impact of Thrombophilia on Risk of Arterial Ischemic Stroke or Cerebral Sinovenous Thrombosis in Neonates and Children A Systematic Review and Meta-Analysis of Observational Studies
Impact of Thrombophilia on Risk of Arterial Ischemic Stroke or Cerebral Sinovenous Thrombosis in Neonates and Children A Systematic Review and Meta-Analysis of Observational Studies
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DOI：
10.1161/circulationaha.109.913673
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发表时间：
2010-04-27
期刊：
影响因子：
37.8
通讯作者：
Nowak-Goettl, Ulrike
中科院分区：
文献类型：
--
作者：
Kenet, Gili;Luetkhoff, Lisa K.;Nowak-Goettl, Ulrike
背景：本研究的目的是通过对已发表的观察性研究的荟萃分析来估计血栓形成对儿童首次中风风险的影响。方法与结果：系统检索电子数据库（Medline通过PubMed， EMBASE， OVID, Web of Science, The Cochrane Library） 1970年至2009年发表的研究。数据包括发表年份、研究设计、原产国、患者/对照受试者人数、种族、卒中类型（动脉缺血性卒中[AIS]、脑静脉窦血栓形成[CSVT]）。评估各研究的发表偏倚指标和异质性，并使用固定效应或随机效应模型计算总结优势比（ORs）和95%置信区间（ci）。185篇文献中有22篇符合纳入标准。因此，共纳入1764例患者（动脉缺血性卒中[AIS]， 1526例；脑窦静脉血栓形成[CSVT]， 238例）和2799例对照组（新生儿至18岁）。研究间未发现显著的异质性，也未发现发表偏倚。每一个被评估的血栓形成特征都与首次卒中有统计学意义的关联，AIS和CSVT之间没有差异。综合or（固定效应模型）如下：抗凝血酶缺乏，7.06 (95% CI, 2.44 ~ 22.42)；蛋白C缺乏，8.76 (95% CI, 4.53 ~ 16.96)；蛋白S缺乏症，3.20 (95% CI, 1.22 ~ 8.40)，因子V G1691A， 3.26 (95% CI, 2.59 ~ 4.10)；因子II G20210A， 2.43 (95% CI, 1.67 ~ 3.51)；MTHFR C677T (AIS), 1.58 (95% CI, 1.20 ~ 2.08)；抗磷脂抗体（AIS）， 6.95 (95% CI, 3.67 ~ 13.14)；脂蛋白升高(a), 6.27 (95% CI， 4.52至8.69)，合并血栓形成，11.86 （95% CI， 5.93至23.73）。在6个专门的围产期AIS研究中，总的or值如下：因素V， 3.56 (95% CI, 2.29 ~ 5.53)；因子II为2.02 （95% CI, 1.02 ~ 3.99）。结论：本荟萃分析表明，血栓形成是卒中发生的危险因素。然而，血栓形成对预后和复发风险的影响需要进一步研究。（Circulation. 2010; 121: 1838-1847）
Background-The aim of this study was to estimate the impact of thrombophilia on risk of first childhood stroke through a meta-analysis of published observational studies.Methods and Results-A systematic search of electronic databases (Medline via PubMed, EMBASE, OVID, Web of Science, The Cochrane Library) for studies published from 1970 to 2009 was conducted. Data on year of publication, study design, country of origin, number of patients/control subjects, ethnicity, stroke type (arterial ischemic stroke [AIS], cerebral venous sinus thrombosis [CSVT]) were abstracted. Publication bias indicator and heterogeneity across studies were evaluated, and summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated with fixed-effects or random-effects models. Twenty-two of 185 references met inclusion criteria. Thus, 1764 patients (arterial ischemic stroke [AIS], 1526; cerebral sinus venous thrombosis [CSVT], 238) and 2799 control subjects (neonate to 18 years of age) were enrolled. No significant heterogeneity was discerned across studies, and no publication bias was detected. A statistically significant association with first stroke was demonstrated for each thrombophilia trait evaluated, with no difference found between AIS and CSVT. Summary ORs (fixed-effects model) were as follows: antithrombin deficiency, 7.06 (95% CI, 2.44 to 22.42); protein C deficiency, 8.76 (95% CI, 4.53 to 16.96); protein S deficiency, 3.20 (95% CI, 1.22 to 8.40), factor V G1691A, 3.26 (95% CI, 2.59 to 4.10); factor II G20210A, 2.43 (95% CI, 1.67 to 3.51); MTHFR C677T (AIS), 1.58 (95% CI, 1.20 to 2.08); antiphospholipid antibodies (AIS), 6.95 (95% CI, 3.67 to 13.14); elevated lipoprotein(a), 6.27 (95% CI, 4.52 to 8.69), and combined thrombophilias, 11.86 (95% CI, 5.93 to 23.73). In the 6 exclusively perinatal AIS studies, summary ORs were as follows: factor V, 3.56 (95% CI, 2.29 to 5.53); and factor II, 2.02 (95% CI, 1.02 to 3.99).Conclusions-The present meta-analysis indicates that thrombophilias serve as risk factors for incident stroke. However, the impact of thrombophilias on outcome and recurrence risk needs to be further investigated. (Circulation. 2010; 121: 1838-1847)