Population Based Birth Prevalence of Disease-Specific Perinatal Stroke
Population Based Birth Prevalence of Disease-Specific Perinatal Stroke
复制标题
DOI：
10.1542/peds.2020-013201
复制
发表时间：
2020-11-01
期刊：
影响因子：
8
通讯作者：
Kirton, Adam
中科院分区：
文献类型：
--
作者：
Dunbar, Mary;Mineyko, Aleksandra;Kirton, Adam
首次基于人群对6种围产期中风亚型出生患病率的估计。背景：围产期中风包括多种疾病特异性脑血管综合征，导致全球数百万人终身神经发育障碍。急性表现包括新生儿动脉缺血性中风(NAIS)、新生儿脑窦静脉血栓形成和新生儿出血性中风(NHS)。延迟的表现包括动脉推定的围产期缺血性中风、脑室周围静脉梗塞和推定的围产期出血性中风。我们的目标是通过基于人群的队列来确定围产期中风所有亚型的出生患病率。方法：艾伯塔省围产期卒中项目是一个研究队列，于2008年在加拿大艾伯塔省南部建立，前瞻性(2008-2017)和回溯性(1990-2008)登记利用单一三级保健儿科中心的全民保健。主要结果是估计每个围产期中风综合征的出生患病率，次要结果是出生患病率随时间的变化、性别比和确诊时的年龄变化。分析方法包括Poisson回归、Wilcoxon等级检验和Fisher精确检验。结果：围产期卒中的总出生患病率估计为1：1100。据估计，新生儿出生患病率为1：3000，动脉推定为围产期缺血性卒中1：7900，脑室周围静脉梗塞1：6000，脑窦静脉血栓形成1：9100，国民保健系统1：6800，围产期出血性卒中1：65000。NAIS和NHS的明显出生流行率随着时间的推移而增加。受影响的男性多于女性。迟发性卒中类型患者的确诊年龄降低。结论：估计的围产期卒中的出生患病率高于以前的估计，这可能是基于人群的疾病特定状态的抽样所解释的。这强调了进一步研究的必要性，以更好地了解疾病特有的病理生理学，以改进治疗和预防策略。
The first population-based estimate of the birth prevalence of the 6 subtypes of perinatal stroke.BACKGROUND: Perinatal stroke encompasses multiple disease-specific cerebrovascular syndromes that cause lifelong neurodevelopmental morbidity for millions worldwide. Acute presentations include neonatal arterial ischemic stroke (NAIS), neonatal cerebral sinovenous thrombosis, and neonatal hemorrhagic stroke (NHS). Delayed presentations include arterial presumed perinatal ischemic stroke, periventricular venous infarction, and presumed perinatal hemorrhagic stroke. Our objective was to define the birth prevalence of all subtypes of perinatal stroke by using a population-based cohort. METHODS: The Alberta Perinatal Stroke Project is a research cohort established in 2008 in southern Alberta, Canada, with prospective (2008-2017) and retrospective (1990-2008) enrollment leveraging universal health care at a single tertiary care pediatric center. The primary outcome was the estimated birth prevalence of each perinatal stroke syndrome, secondary outcomes were birth prevalence over time, sex ratios, and change in age at diagnosis. Analysis included Poisson regression, Wilcoxon rank test, and Fisher exact test. RESULTS: The overall estimated birth prevalence of term-born perinatal stroke was 1:1100. The estimated birth prevalence was 1:3000 for NAIS, 1:7900 for arterial presumed perinatal ischemic stroke, 1:6000 for periventricular venous infarction, 1:9100 for cerebral sinovenous thrombosis, 1:6800 for NHS, and 1:65000 for presumed perinatal hemorrhagic stroke. The apparent birth prevalence of NAIS and NHS increased over time. There were more males affected than females. The age at diagnosis decreased for late-presenting stroke types. CONCLUSIONS: The estimated birth prevalence of term perinatal stroke is higher than previous estimates, which may be explained by population-based sampling of disease-specific states. This emphasizes the need for further studies to better understand the disease-specific pathophysiology to improve treatment and prevention strategies.