Differential cerebral hemometabolic responses to blood transfusions in adults and children with sickle cell anemia
Differential cerebral hemometabolic responses to blood transfusions in adults and children with sickle cell anemia
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DOI：
10.1002/jmri.26213
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发表时间：
2019-02-01
影响因子：
4.4
通讯作者：
Jordan, Lori C.
中科院分区：
文献类型：
--
作者：
Juttukonda, Meher R.;Lee, Chelsea A.;Jordan, Lori C.
背景：儿童和成人镰状细胞性贫血（SCA）患者可通过输血预防继发性卒中，或治疗复发性疼痛危象或急性贫血，但输血对脑血流动力学和代谢的影响尚不清楚。目的比较成人和儿童SCA患者输血引起的血液代谢参数的变化，包括氧提取分数（OEF）和脑血流量（CBF）。研究类型前瞻性、纵向研究。接受简单输血（n = 7）或交换输血（n = 9）的SCA成人（n = 16）和接受交换输血的SCA儿童（n = 11）在红细胞比容接近最低点时进行一次扫描，并在输血后7天内再次扫描。没有SCA或镰状性状的成人对照（n = 7）在不同的天进行两次扫描。场强/序列3.0T t -1加权、t -2加权和t -2自旋下松弛标记（TRUST）成像和相衬血管造影。Global OEF计算为静脉氧合（来自TRUST）和动脉氧合（来自脉搏血氧测定）之间的相对差异。总体脑血流是通过颅内组织体积归一化的脑总血流量来计算的。采用双侧Wilcoxon符号秩检验比较血液代谢变量；采用双侧Spearman相关检验分析相关关系。结果成人SCA患者输血后OEF = 0.38 +/- 0.05低于输血前OEF = 0.45 +/- 0.09 （P = 0.001）。OEF的变化与红细胞压积的增加（P = 0.02; rho = -0.62）和输血前红细胞压积的增加（P = 0.02; rho = 0.65）相关。输血后OEF的变化在接受简单输血和交换输血的成年人中更大（P = 0.002）。输血后CBF = 77.7 +/- 26.4 ml/100g/min与输血前CBF = 82.3 +/- 30.2 ml/100g/min差异无统计学意义（P = 0.27）。在SCA患儿中，输血后OEF = 0.28 +/- 0.04和CBF = 76.4 +/- 26.4均低于输血前OEF = 0.36 +/- 0.06 （P = 0.004）和CBF = 96.4 +/- 16.5 （P = 0.004）。结论成人和儿童SCA患者输血后脑OEF降低。与成人相比，儿童输血后脑血流减少的情况更常见，这表明许多成年人输血后血管储备能力可能仍接近衰竭。技术功效阶段5 [j]。的原因。成像2019;49:466 - 477。
Background Blood transfusions are administered to children and adults with sickle cell anemia (SCA) for secondary stroke prevention, or as treatment for recurrent pain crises or acute anemia, but transfusion effects on cerebral hemodynamics and metabolism are not well-characterized. Purpose To compare blood transfusion-induced changes in hemometabolic parameters, including oxygen extraction fraction (OEF) and cerebral blood flow (CBF), within and between adults and children with SCA. Study Type Prospective, longitudinal study. Subjects Adults with SCA (n = 16) receiving simple (n = 7) or exchange (n = 9) transfusions and children with SCA (n = 11) receiving exchange transfusions were scanned once when hematocrit was near nadir and again within 7 days of transfusion. Adult controls without SCA or sickle trait (n = 7) were scanned twice on separate days. Field Strength/Sequence 3.0T T-1-weighted, T-2-weighted, and T-2-relaxation-under-spin-tagging (TRUST) imaging, and phase contrast angiography. Assessment Global OEF was computed as the relative difference between venous oxygenation (from TRUST) and arterial oxygenation (from pulse oximetry). Global CBF was computed as total blood flow to the brain normalized by intracranial tissue volume. Statistical Tests Hemometabolic variables were compared using two-sided Wilcoxon signed-rank tests; associations were analyzed using two-sided Spearman's correlation testing. Results In adults with SCA, posttransfusion OEF = 0.38 +/- 0.05 was lower (P = 0.001) than pretransfusion OEF = 0.45 +/- 0.09. A change in OEF was correlated with increases in hematocrit (P = 0.02; rho = -0.62) and with pretransfusion hematocrit (P = 0.02; rho = 0.65). OEF changes after transfusion were greater (P = 0.002) in adults receiving simple versus exchange transfusions. Posttransfusion CBF = 77.7 +/- 26.4 ml/100g/min was not different (P = 0.27) from pretransfusion CBF = 82.3 +/- 30.2 ml/100g/min. In children with SCA, both posttransfusion OEF = 0.28 +/- 0.04 and CBF = 76.4 +/- 26.4 were lower than pretransfusion OEF = 0.36 +/- 0.06 (P = 0.004) and CBF = 96.4 +/- 16.5 (P = 0.004). Data Conclusion Cerebral OEF reduces following transfusions in adults and children with SCA. CBF reduces following transfusions more often in children compared to adults, indicating that vascular reserve capacity may remain near exhaustion posttransfusion in many adults. Technical Efficacy Stage 5 J. Magn. Reson. Imaging 2019;49:466-477.