Predictors of cerebral arteriopathy in children with arterial ischemic stroke: results of the International Pediatric Stroke Study.
Predictors of cerebral arteriopathy in children with arterial ischemic stroke: results of the International Pediatric Stroke Study.
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DOI：
10.1161/circulationaha.108.806307
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发表时间：
2009-03-17
期刊：
影响因子：
37.8
通讯作者：
International Pediatric Stroke Study Group
中科院分区：
文献类型：
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作者：
Amlie-Lefond C;Bernard TJ;Sébire G;Friedman NR;Heyer GL;Lerner NB;DeVeber G;Fullerton HJ;International Pediatric Stroke Study Group
脑动脉病变，包括特发性儿童局灶性脑动脉病(FCA)，在动脉缺血性中风(AIS)的儿童中很常见，并强烈预测复发。为了更好地了解这些损害，我们在一大批国际AIS儿童中测量了动脉病变的预测因素。2003年1月至2007年7月，国际儿童卒中研究(IPSS)内的30个中心招募了667名患有AIS的儿童(29天-19岁)，并提取了临床和放射数据。根据已发表的定义定义脑动脉病及其亚型；FCA被定义为不属于特定诊断的脑动脉狭窄，如烟雾病、动脉夹层、血管炎或水痘后血管病。我们使用多变量Logistic回归技术在接受血管成像的受试者中确定动脉病变和FCA的预测因素。提交人对数据的完整性拥有完全访问权，并对其承担全部责任。所有作者都已阅读并同意原稿。在667名受试者中，525人有已知的血管成像结果，其中53%(n=277)有动脉病变。最常见的动脉病变是FCA(n=69，25%)、烟雾(n=61，22%)和动脉夹层(n=56，20%)。动脉病的预测因素包括早期学龄(5-9岁)、最近的上呼吸道感染(URI)和镰状细胞病，而既往心脏病和脓毒症降低了动脉病的风险。FCA的唯一预测因子是最近的URI。动脉病在AIS儿童中很常见，特别是那些早期学龄儿童和有镰状细胞病史的儿童。最近的URI预测了脑动脉病变，特别是FCA，提示感染在这些病变的发病机制中可能发挥了作用。
Cerebral arteriopathies, including an idiopathic focal cerebral arteriopathy of childhood (FCA), are common in children with arterial ischemic stroke (AIS) and strongly predictive of recurrence. To better understand these lesions, we measured predictors of arteriopathy within a large international series of children with AIS. Between 1/2003 and 7/2007, 30 centers within the International Pediatric Stroke Study (IPSS) enrolled 667 children (29 days-19 years of age) with AIS and abstracted clinical and radiographic data. Cerebral arteriopathy and its subtypes were defined using published definitions; FCA was defined as cerebral arterial stenosis not attributed to specific diagnoses such as moyamoya, arterial dissection, vasculitis, or post-varicella angiopathy. We used multivariate logistic regression techniques to determine predictors of arteriopathy and FCA among those subjects who received vascular imaging. The authors had full access to and take full responsibility for the integrity of the data. All authors have read and agree to the manuscript as written. Of 667 subjects, 525 had known vascular imaging results, and 53% of those (n=277) had an arteriopathy. The most common arteriopathies were FCA (n=69, 25%), moyamoya (n=61, 22%), and arterial dissection (n=56; 20%). Predictors of arteriopathy include early school age (5-9 years), recent upper respiratory infections (URI), and sickle cell disease, while prior cardiac disease and sepsis reduced the risk of arteriopathy. The only predictor of FCA was recent URI. Arteriopathy is prevalent among children with AIS, particularly those presenting in early school age, and those with a history of sickle cell disease. Recent URI predicted cerebral arteriopathy, and FCA in particular, suggesting a possible role for infection in the pathogenesis of these lesions.