The Role of Infection in Childhood Stroke

描述(申请人提供)：中风是儿童残疾的一个日益公认的原因，每年每100,000名儿童中就有13人发生中风。尽管认识有所改善，但我们对这种疾病的病理生理学的了解仍然有限。更好的了解可以改善我们对这些儿童的照顾，也有助于揭示中风的非动脉粥样硬化机制，无论是儿童还是成人都适用。感染可能是儿童卒中的重要危险因素，要么是由于炎症介质的全身作用导致相对血栓前状态，要么是通过各种机制直接或间接作用于血管。这个项目的总体目标是探索感染在儿童中风中的作用，从而提高我们对这种疾病潜在机制的理解。这项研究的具体目的是：1)确定感染(最近的发烧感染、严重的急性感染，如脑膜炎和远程水痘)是否为首次儿童中风的风险因素；2)确定首次中风前的感染史是否预测中风的复发；以及3)确定针对水痘带状疱疹病毒、流感病毒和脑膜炎的细菌病原体的疫苗是否对儿童中风具有保护作用。我们建议在凯撒永久医疗保健计划(KPMCP)登记的大约100万名儿童中进行一项病例对照研究，该计划是一个健康维护组织，包括16家医院和36家门诊机构，位于加利福尼亚州北部。我们将纳入17年(1993至2009年)期间所有中风儿童作为病例；对照将从毕马威会计师事务所人群中随机选择并按年龄匹配。接触史将通过审查电子和传统医疗记录，以及通过电话采访受试者或他们的代理人来衡量。公共卫生相关性：这项研究将提高我们对为什么儿童中风的理解，中风是导致终生身体和精神残疾的重要原因，往往发生在最小的儿童，也就是生命第一年的儿童。了解为什么中风会发生在儿童身上，是设计有效预防中风方法的第一步。

DESCRIPTION (provided by applicant): Stroke is an increasingly recognized cause of childhood disability, occurring in as many as 13 per 100,000 children per year. Despite improved recognition, our understanding of the pathophysiology of this disease remains limited. A better understanding could improve our care of these children, and also shed light on non-atherosclerotic mechanisms of stroke applicable to both children and adults. Infection may be an important risk factor for childhood stroke, either due to systemic effects of inflammatory mediators causing a relatively pro-thrombotic state, or by direct or indirect effects on blood vessels through a variety of mechanisms. The overall goal of this project is explore the role of infection in childhood stroke, and thereby improve our understanding of the mechanisms underlying this disease. The Specific Aims of the study are: 1) to determine whether infections (recent febrile infection, severe acute infections such as meningitis and remote chicken pox) are risk factors for first childhood stroke; 2) to determine whether a history of infection prior to a first stroke predicts stroke recurrence, and 3) to determine whether vaccinations against varicella-zoster virus, influenza virus and bacterial etiologies of meningitis are protective against childhood stroke. We propose a case-control study within the well-defined population of approximately 1 million children enrolled in Kaiser Permanente Medical Care Program (KPMCP), a health maintenance organization including 16 hospitals and 36 out-patient facilities in Northern California. We will include as cases all children with stroke over a 17 year time period (1993 to 2009); controls will be randomly selected from the KPMCP population and matched for age. Exposure history will be measured through review of electronic and traditional medical records, and by telephone interview of subjects or their surrogates. Public Health Relevance: This study will improve our understanding of why children have strokes, an important cause of life-long physical and mental disability that tends to occur in the very youngest of children, those in the first year of life. Understanding why strokes occur in children is the first step towards designing effective methods of preventing stroke.