Herpesvirus Infections and Childhood Arterial Ischemic Stroke: Results of the VIPS Study.
Herpesvirus Infections and Childhood Arterial Ischemic Stroke: Results of the VIPS Study.
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DOI：
10.1161/circulationaha.115.018595
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发表时间：
2016-02-23
期刊：
影响因子：
37.8
通讯作者：
VIPS Investigators*
中科院分区：
文献类型：
--
作者：
Elkind MS;Hills NK;Glaser CA;Lo WD;Amlie-Lefond C;Dlamini N;Kneen R;Hod EA;Wintermark M;deVeber GA;Fullerton HJ;VIPS Investigators*
流行病学研究表明，儿童感染，包括水痘带状疱疹病毒（VZV），与动脉缺血性中风（AIS）的风险增加有关。在病例报告中，其他疱疹病毒与儿童AIS有关。我们试图确定是否疱疹病毒感染，这是潜在的可治疗的，增加儿童AIS的风险。我们入组了326例中心确认的AIS病例和115例无卒中对照创伤（年龄29天-18岁），并采集了急性血液样本（卒中/创伤后≤3周）;可行时，病例采集了恢复期样本（7-28天后）。通过商业ELISA试剂盒检测样本中单纯疱疹病毒（HSV）1和2、巨细胞病毒（CMV）、爱泼斯坦巴尔病毒（EBV）和水痘带状疱疹病毒（VZV）的IgM/IgG抗体。一个算法开发了一个先验的分类血清学证据的过去和急性疱疹病毒感染的二分变量。病例组的中位年龄（四分位数）为7.7（3.1-14.3）岁，对照组为10.7（6.9-13.2）岁（p=0.03）。既往感染的血清学证据在病例组和对照组之间没有差异。然而，急性疱疹病毒感染的血清学证据使儿童AIS的几率增加了一倍，即使在调整了年龄，种族和社会经济状况之后（OR 2.2; 95%置信区间，1.2-4.0; p=0.007）。在187例急性和恢复期血液样本中，85例（45%）显示急性疱疹病毒感染的证据，最常见的是HSV-1。大多数感染者无症状。疱疹病毒可能是儿童AIS的触发因素，即使感染是亚临床的。如果进一步的研究证实了因果关系，像阿昔洛韦这样的抗病毒药物可能在预防复发性中风中发挥作用。
Epidemiological studies demonstrate that childhood infections, including varicella zoster virus (VZV), are associated with an increased risk of arterial ischemic stroke (AIS). Other herpesviruses have been linked to childhood AIS in case reports. We sought to determine whether herpesvirus infections, which are potentially treatable, increase risk of childhood AIS. We enrolled 326 centrally-confirmed cases of AIS and 115 stroke-free controls with trauma (ages 29 days-18 years) with acute blood samples (≤3 weeks after stroke/trauma); cases had convalescent samples (7-28 days later) when feasible. Samples were tested by commercial ELISA kits for IgM/IgG antibodies to herpes simplex virus (HSV) 1 and 2, cytomegalovirus (CMV), Epstein Barr virus (EBV), and varicella zoster virus (VZV). An algorithm developed a priori classified serologic evidence of past and acute herpesvirus infection as dichotomous variables. Median (quartiles) age was 7.7 (3.1-14.3) years for cases and 10.7 (6.9-13.2) for controls (p=0.03). Serologic evidence of past infection did not differ between cases and controls. However, serologic evidence of acute herpesvirus infection doubled the odds of childhood AIS, even after adjusting for age, race, and socio-economic status (OR 2.2; 95% confidence interval, 1.2-4.0; p=0.007). Among 187 cases with acute and convalescent blood samples, 85 (45%) showed evidence of acute herpesvirus infection, with HSV-1 found most often. Most infections were asymptomatic. Herpesviruses may act as a trigger for childhood AIS, even if the infection is subclinical. Antivirals like acyclovir might have a role in the prevention of recurrent stroke if further studies confirm a causal relationship.