近期机械性静脉血栓危险因素与青年隐源性缺血性卒中相关性
这项多中心性别和年龄匹配的病例对照研究纳入546例18至49岁隐源性缺血性卒中患者及546名无卒中社区对照。研究评估卒中前90天内的手术、非手术干预、损伤和制动等机械性静脉血栓危险因素。结果显示卒中前14天内的机械性静脉血栓危险因素与青年隐源性缺血性卒中独立相关，尤其在18至39岁人群及具有临床意义卵圆孔未闭者中更明显。
要点
- 卒中前14天内机械性静脉血栓危险因素较多者青年隐源性卒中风险升高。
- 18至39岁及有临床意义卵圆孔未闭者该关联更显著。
- 卒中前15至90天的机械性危险因素未显示显著关联。
核心结论
- 卒中前14天内发生的近期机械性静脉血栓危险因素增加青年隐源性缺血性卒中风险。
- 该风险在18至39岁人群和具有临床意义卵圆孔未闭者中更突出。
- 基线血液易栓症标志物在有无机械性静脉血栓危险因素的病例间无差异。
研究设计与样本
- 多中心性别和年龄匹配的病例对照研究，纳入546例18至49岁近期隐源性缺血性卒中患者及546名无卒中社区对照。
- 条件logistic回归分析机械性静脉血栓危险因素与隐源性缺血性卒中的关联，校正年龄、性别、教育水平及传统和非传统卒中危险因素。
主要发现
- 卒中前14天内机械性静脉血栓危险因素在病例组为15.4%，对照组为9.6%。
- 校正人口学和传统卒中危险因素后，卒中前14天内机械性静脉血栓危险因素的比值比为1.67（95%CI 1.05至2.67）。
- 18至39岁组额外校正非传统危险因素后比值比为2.36（95%CI 1.02至5.46），40至49岁组为1.50（95%CI 0.73至3.08）。
- 具有临床意义卵圆孔未闭者校正后比值比为2.06（95%CI 1.21至3.51），无卵圆孔未闭者为1.29（95%CI 0.76至2.18）。
- 卒中前15至90天发生机械性静脉血栓危险因素未显示显著关联。
关键数值与推荐
- 机械性静脉血栓危险因素包括外科手术、非手术干预、损伤和制动，评估卒中前90天内发生情况。
- 卒中前14天内机械性静脉血栓危险因素病例组15.4%，对照组9.6%。
- 18至39岁组比值比2.36（95%CI 1.02至5.46），40至49岁组比值比1.50（95%CI 0.73至3.08）。
- 具有临床意义卵圆孔未闭者比值比2.06（95%CI 1.21至3.51）。
临床怎么用
- 对青年隐源性缺血性卒中患者应询问卒中前14天内手术、制动、损伤等机械性静脉血栓危险因素。
- 伴近期机械性危险因素者需关注卵圆孔未闭的评估。
- 近期机械性危险因素相关卒中风险似乎不通过血液易栓症标志物介导。
局限性
- 病例对照设计不能确立因果关系，可能存在回忆偏倚。
- 机械性静脉血栓危险因素通过结构化访谈收集，缺乏客观记录验证。
- 未报告机械性危险因素的具体类型分布及严重程度。
- 血液易栓症标志物仅作基线比较，未提供具体检测项目。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
Stroke, Volume 57, Issue 10, Page 3010-3023, October 1, 2026. BACKGROUND:In young adults, the risk factors (RFs) for cryptogenic ischemic stroke (CIS) remain unclear. We aimed to investigate the association between recent mechanical venous thrombosis RFs (VTRFs) and young-onset CIS in this multicenter sex- and age-matched case-control study.METHODS:Five hundred forty-six patients aged 18 to 49 years (median age, 41 [34–46] years; 47.3% women) with a recent CIS and 546 stroke-free community-based controls were included in the study across 19 European centers between October 2013 and November 2022. Mechanical VTRFs, including surgical treatment, nonsurgical intervention, injury, and immobilization occurring within 90 days prestroke, were assessed using standardized, structured interviews. Conditional logistic regression was used to assess the association of mechanical VTRFs with CIS. Age, sex, level of education, and traditional and nontraditional stroke RFs were included as confounders.RESULTS:Mechanical VTRFs within 14 days prestroke were more prevalent in cases than controls (15.4% versus 9.6%) and independently associated with CIS after adjustment for demographics and traditional stroke RFs (odds ratio [OR], 1.67 [95% CI, 1.05–2.67]). In age-stratified analysis, this association remained significant after additional adjustment for nontraditional RFs in 18- to 39-year-olds (OR, 2.36 [95% CI, 1.02–5.46]) but was not significant in the 40- to 49-year age group (OR, 1.50 [95% CI, 0.73–3.08]). In addition, mechanical VTRFs were associated with CIS in cases with clinically relevant patent foramen ovale in a fully adjusted model (OR, 2.06 [95% CI, 1.21–3.51]) but not in those without (OR, 1.29 [95% CI, 0.76–2.18]). No significant associations were observed for mechanical VTRFs occurring >14 days before stroke. Baseline blood thrombophilia markers did not differ between cases with and without mechanical VTRFs 0 to 14 or 15 to 90 days before stroke.CONCLUSIONS:Recent mechanical VTRFs occurring within 14 days preceding stroke contribute to the risk of young-onset CIS, particularly in younger individuals and those with a clinically relevant patent foramen ovale. This risk does not appear to be conveyed by thrombophilic factors assessed.REGISTRATION:URL:https://www.clinicaltrials.gov; Unique identifier: NCT01934725.
引用
- Stroke：Association Between Recent Mechanical Risk Factors for Venous Thrombosis and Young-Onset Cryptogenic Ischemic Stroke
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。