Transcranial Doppler Ultrasonography Provides Insights into Neurovascular Changes in Children with Cerebral Malaria
Transcranial Doppler Ultrasonography Provides Insights into Neurovascular Changes in Children with Cerebral Malaria
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DOI：
10.1016/j.jpeds.2018.07.075
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发表时间：
2018-12-01
影响因子：
5.1
通讯作者：
Yotebieng, Marcel
中科院分区：
文献类型：
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作者：
O'Brien, Nicole Fortier;Taty, Tshimanga Mutatshi;Yotebieng, Marcel
目的评价脑型疟疾患儿的神经血管改变，研究设计入选非洲脑型疟疾患儿，每天进行经颅多普勒超声（TCD）检查，直至住院第8天、出院或死亡。神经功能的结果进行了评估后2 wk enrollment.Results，共160例脑型疟疾和155例对照患者被纳入。脑型疟患者TCD血流改变以充血为主者42例（26%）。低血流46例（28%），微血管阻塞35例（22%），脑血管痉挛21例（13%）。孤立性后部充血7例（4%）。在整个参与过程中观察到大多数人具有单一的神经血管表型。在对照组中，76%的患者TCD正常（P <0.001）。80%的病例存在自身调节受损（一过性充血反应比1.01 +/- 0.03），但在第4天有所改善（1.1 +/- 0.02，P= 0.014）。总死亡率为24%（n = 39）。21%的幸存者有明显的神经功能缺损。符合血管痉挛标准的儿童最有可能存活并留下后遗症，而符合低血流标准的儿童最有可能死亡。神经功能正常儿童的自我调节功能（1.09，95%CI 1.06-1.12）优于其他儿童（0.98，95%CI 0.95-1）（P
Objective To evaluate neurovascular changes in pediatric patients with cerebral malaria.Study design African children with cerebral malaria were enrolled and underwent daily transcranial Doppler ultrasound (TCD) examinations through hospital day 8, discharge, or death. Neurologic outcomes were assessed 2 weeks after enrollment.Results In total, 160 children with cerebral malaria and 155 comparison patients were included. In patients with cerebral malaria, TCD flow changes characterized as hyperemia were seen in 42 (26%). low flow in 46 (28%), microvascular obstruction in 35 (22%), cerebral vasospasm in 21 (13%). and isolated posterior hyperemia in 7 (4%). Most had a single neurovascular phenotype observed throughout participation. Among comparison patients, 76% had normal TCD findings (P < .001). Impaired autoregulation was present in 80% of cases (transient hyperemic response ratio 1.01 +/- 0.03) but improved through day 4 (1.1 +/- 0.02, P= .014). Overall mortality was 24% (n = 39). Neurologic deficits were evident in 21% of survivors. Children meeting criteria for vasospasm were most likely to survive with sequelae, and children meeting criteria for low flow were most likely to die. Autoregulation was better in children with a normal neurologic outcome (1.09, 95% CI 1.06-1.12) than in others (0.98, 95% CI 0.95-1) (P