Prevention of a first stroke by transfusions in children with sickle, cell anemia and abnormal results on transcranial Doppler ultrasonography
Prevention of a first stroke by transfusions in children with sickle, cell anemia and abnormal results on transcranial Doppler ultrasonography
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DOI：
10.1056/nejm199807023390102
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发表时间：
1998-07-02
影响因子：
158.5
通讯作者：
Wiznitzer, M
中科院分区：
文献类型：
--
作者：
Adams, RJ;McKie, VC;Wiznitzer, M
背景 输血可预防镰状细胞性贫血儿童复发性中风，但输血在预防首次中风方面的价值尚不清楚。我们使用经颅多普勒超声检查来识别患有中风高风险的镰状细胞贫血儿童，然后随机分配他们接受标准护理或输血以预防首次中风。 方法 为了进入研究，没有中风病史的镰状细胞贫血儿童必须接受两次经颅多普勒研究，结果显示颈内动脉的时间平均平均血流速度 或大脑中动脉每秒200厘米或更高。患者被随机分配接受标准护理或输血，以将血红蛋白 S 浓度降低至总血红蛋白浓度的 30% 以下。比较两组脑卒中（脑梗塞或颅内出血）的发生率。 结果 共有130名儿童（平均[+/- SD]年龄，8.3 +/- 3.3岁）入组； 63 人被随机分配接受输血，67 人接受标准护理。基线时，输血组的平均血红蛋白浓度（7.2% vs. 7.6 g/dL，P = 0.001）和血细胞比容（20.4% vs. 21.7%，P = 0.002）略低。十名患者退出输血组，两名患者从标准护理组转入输血组。脑梗塞10例，？标准护理组中发生脑内血肿，与输血组中发生 1 例梗塞相比，中风风险相差 92%（P
Background Blood transfusions prevent recurrent stroke in children with sickle cell anemia, but the value of transfusions in preventing a first stroke is unknown. We used transcranial Doppler ultrasonography to identify children with sickle cell anemia who were at high risk for stroke and then randomly assigned them to receive standard care or transfusions to prevent a first stroke.Methods To enter the study, children with sickle cell anemia and no history of stroke had to have undergone two transcranial Doppler studies that showed that the time-averaged mean blood-flow velocity in the internal carotid or middle cerebral artery was 200 cm per second or higher. The patients were randomly assigned to receive standard care or transfusions to reduce the hemoglobin S concentration to less than 30 percent of the total hemoglobin concentration. The incidence of stroke (cerebral infarction or intracranial hemorrhage) was compared between the two groups.Results A total of 130 children (mean [+/- SD] age, 8.3 +/- 3.3 years) were enrolled; 63 were randomly assigned to receive transfusions, and 67 to receive standard care. At base line, the transfusion group had a slightly lower mean hemoglobin concentration (7.2 vs. 7.6 g per deciliter, P = 0.001) and hematocrit (20.4 vs. 21.7 percent, P = 0.002). Ten patients dropped out of the transfusion group, and two patients crossed over from the standard-care group to the transfusion group. There were 10 cerebral infarctions and ? intracerebral hematoma in the standard-care group, as compared with 1 infarction in the transfusion group - a 92 percent difference in the risk of stroke (P