The Role of Infection in Childhood Stroke

描述（由申请人提供）：中风是一个日益认识到的儿童残疾的原因，发生在多达13每10万名儿童每年。尽管认识有所提高，但我们对这种疾病的病理生理学的理解仍然有限。更好的理解可以改善我们对这些儿童的护理，也可以阐明适用于儿童和成人的中风的非动脉粥样硬化机制。感染可能是儿童卒中的一个重要危险因素，这可能是由于炎症介质的全身作用引起相对的促血栓形成状态，或者通过各种机制对血管产生直接或间接影响。该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的潜在机制的理解。研究的具体目的是：1）确定是否感染（近期发热感染、严重急性感染如脑膜炎和陈旧性水痘）是首次儿童中风的危险因素; 2）确定第一次中风前的感染史是否预示中风复发，和3）确定是否接种水痘-带状疱疹病毒疫苗，流感病毒和细菌性脑膜炎病原学可预防儿童中风。我们提出了一个病例对照研究，在明确定义的人口约100万儿童参加凯撒永久医疗保健计划（KPMCP），一个健康维护组织，包括16家医院和36个门诊设施在北方加州。我们将纳入17年（1993年至2009年）内所有中风儿童的病例;对照组将从KPMCP人群中随机选择，并进行年龄匹配。将通过审查电子和传统病历以及通过电话访谈受试者或其代理人来测量暴露史。公共卫生相关性：这项研究将提高我们对儿童中风原因的理解，中风是导致终身身体和精神残疾的重要原因，往往发生在最年幼的儿童，即生命的第一年。了解儿童中风发生的原因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.