Hydroxyurea reduces cerebral metabolic stress in patients with sickle cell anemia
Hydroxyurea reduces cerebral metabolic stress in patients with sickle cell anemia
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DOI：
10.1182/blood-2018-09-876318
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发表时间：
2019-05-30
期刊：
影响因子：
20.3
通讯作者：
Ford, Andria L.
中科院分区：
文献类型：
--
作者：
Fields, Melanie E.;Guilliams, Kristin P.;Ford, Andria L.
慢性输血治疗（CTT）可预防选定的镰状细胞性贫血（SCA）患者发生卒中。我们已经证明，CTT减轻脑代谢应激的特征，反映在氧提取分数（OEF）升高，这可能会降低中风风险。OEF最高的区域位于脑血流量（CBF）最低点的边界区域内，福尔斯; CTT后该区域的OEF降低。羟基脲（HU）的神经保护作用尚不清楚。为了验证我们的假设，即接受HU治疗的患者与未接受疾病改善治疗的患者相比，脑代谢应激较低，我们前瞻性地获得了84名SCA患者的脑磁共振成像扫描，并进行了CBF和OEF的体素测量，这些患者按治疗分组：未接受疾病改善治疗、HU或CTT。3个队列的全脑CBF无差异（P = .148）。而全脑OEF差异有显著性（P
Chronic transfusion therapy (CTT) prevents stroke in selected patients with sickle cell anemia (SCA). We have shown that CTT mitigates signatures of cerebral metabolic stress, reflected by elevated oxygen extraction fraction (OEF), which likely drives stroke risk reduction. The region of highestOEF falls within the border zone, where cerebral blood flow(CBF) nadirs; OEF in this region was reduced after CTT. The neuroprotective efficacy of hydroxyurea (HU) remains unclear. To test our hypothesis that patients receiving HU therapy have lower cerebral metabolic stress compared with patients not receiving disease-modifying therapy, we prospectively obtained brain magnetic resonance imaging scans with voxel-wise measurements of CBF and OEF in 84 participantswith SCAwhowere grouped by therapy: no disease-modifying therapy, HU, or CTT. There was no difference in whole-brain CBF among the 3 cohorts (P = .148). However, whole-brain OEF was significantly different (P