THE USE OF TRANSCRANIAL ULTRASONOGRAPHY TO PREDICT STROKE IN SICKLE-CELL DISEASE
THE USE OF TRANSCRANIAL ULTRASONOGRAPHY TO PREDICT STROKE IN SICKLE-CELL DISEASE
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DOI：
10.1056/nejm199202273260905
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发表时间：
1992-02-27
影响因子：
158.5
通讯作者：
HESS, D
中科院分区：
文献类型：
--
作者：
ADAMS, R;MCKIE, V;HESS, D
背景 卒中，尤其是脑梗死，是镰状细胞病患儿发病和死亡的主要原因。如果有一种方法可以识别出风险最大的患者，那么通过输血治疗进行卒中的一级预防可能是可行的。经颅多普勒超声可以测量颅内大动脉的血流速度，这些动脉的狭窄导致脑梗死，其特征是血流速度增加。 使用经颅多普勒超声，我们前瞻性地测量了儿童和年轻人的脑血流速度，因为镰状细胞病。根据大脑中动脉的最高流速将结果分为正常或异常。异常流速定义为流速大于或等于170 cm/s，该定义通过事后分析确定，以最大限度地提高试验的预测成功率。终点为临床上明显的首次脑梗死。 对190例镰状细胞病患者（入组时年龄为3 ~ 18岁）进行了283次经颅超声检查。经过平均29个月的随访，7名患者被诊断为脑梗死。23例患者的超声检查结果异常，167例患者的结果正常。两组患者的临床和血液学特征相似，但7例中风中有6例发生在23例超声结果异常的患者中（Fisher精确检验P < 0.00001）。在这一组中，中风的相对危险度为44（95%置信区间，5.5至346）。 经颅超声检查可以识别镰状细胞病儿童，他们是脑梗死的高危人群。定期超声检查和选择性使用输血治疗可以使卒中的一级预防成为一个可实现的目标。
Background. Stroke, especially cerebral infarction, is a major cause of morbidity and mortality in children with sickle cell disease. Primary prevention of stroke by transfusion therapy may be feasible if there is a way to identify the patients at greatest risk. Transcranial Doppler ultrasonography can measure flow velocity in the large intracranial arteries, The narrowing of these arteries, which leads to cerebral infarction, is characterized by an increased velocity of flow.Methods. Using transcranial Doppler ultrasonography, we prospectively measured the velocity of cerebral blood flow in children and young adults being followed because of sickle cell disease. The results were classified as either normal or abnormal on the basis of the highest velocity of flow in the middle cerebral artery. Abnormal velocity was defined as a flow greater-than-or-equal-to 170 cm per second, a definition determined by post hoc analysis to maximize the predictive success of the test. The end point was a clinically apparent first cerebral infarction.Results. Two hundred eighty-three transcranial ultrasound examinations were performed in 190 patients with sickle cell disease (age at entry, 3 to 18 years). After an average follow-up of 29 months, cerebral infarction was diagnosed in seven patients. In 23 patients the results of the ultrasound examinations were abnormal, and in 167 patients they were normal. The clinical and hematologic characteristics of the two groups were similar, but six of the seven strokes occurred among the 23 patients with abnormal ultrasound results (P < 0.00001 by Fisher's exact test). In this group, the relative risk of stroke was 44 (95 percent confidence interval, 5.5 to 346).Conclusions. Transcranial ultrasonography can identify the children with sickle cell disease who are at highest risk for cerebral infarction. Periodic ultrasound examinations and the selective use of transfusion therapy could make the primary prevention of stroke an achievable goal.