Reduced incidence of ischemic stroke in patients with severe factor XI deficiency

Reduced incidence of ischemic stroke in patients with severe factor XI deficiency
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DOI：
10.1182/blood-2007-10-120139
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发表时间：
2008-04-15
期刊：
BLOOD
影响因子：
20.3
通讯作者：
Seligsohn, Uri
Seligsohn, Uri
中科院分区：
医学1区
文献类型：
--
作者：
Salomon, Ophira;Steinberg, David M.;Seligsohn, Uri

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遗传性止血障碍是研究血栓形成机制和开发抗血栓治疗的天然模型。由于总因子XI缺乏的小鼠对缺血性中风有保护作用，并且没有表现出过度出血，因此我们研究了严重遗传性因子XI缺乏患者的缺血性中风发病率。将115例年龄在45岁或45岁以上的严重因子XI缺乏症（活性低于15 U/dL）患者的缺血性卒中发病率与以色列人群中1528例卒中调查估计的发病率进行比较。调整中风的主要危险因素（高血压，糖尿病，高胆固醇血症，目前吸烟）的基础上比较他们的患病率在中风调查以色列的健康调查9509名受试者。还记录了因子XI队列中心肌梗死的发生率。调整缺血性中风的4个主要危险因素后，缺血性中风的预期发生率为8.56，而观察到的发生率为8.56（P = 0.003）。缺血性中风的发生率降低了1：115，而心肌梗死的发生率为19：115，与预期的发生率相似。因此，严重的因子XI缺乏可能对缺血性中风有保护作用，但对急性心肌梗死无保护作用。
Inherited disorders of hemostasis are natural models for investigating mechanisms of thrombosis and development of antithrombotic therapy. Because mice with total factor XI deficiency are protected against ischemic stroke and do not manifest excessive bleeding, we investigated the incidence of ischemic stroke in patients with severe inherited factor XI deficiency. Incidence of ischemic stroke in 115 patients aged 45 years or more with severe factor XI deficiency (activity less than 15 U/dL) was compared with incidence in the Israeli population as estimated from a stroke survey of 1528 patients. Adjustment for major risk factors of stroke (hypertension, diabetes mellitus, hypercholesterolemia, current smoking) was based on comparison of their prevalence in the stroke survey to an Israeli health survey of 9509 subjects. Incidence of myocardial infarction in the factor XI cohort was also recorded. After adjustment for the 4 major risk factors of ischemic stroke, the expected incidence of ischemic stroke was 8.56 compared with one observed (P =.003). The reduced 1:115 incidence of ischemic stroke contrasted with a 19:115 incidence of myocardial infarction, similar to the expected incidence. Thus, severe factor XI deficiency probably is protective against ischernic stroke but not against acute myocardial infarction.