Quantifying the Cerebral Hemometabolic Response to Blood Transfusion in Pediatric Sickle Cell Disease With Diffuse Optical Spectroscopies.
Quantifying the Cerebral Hemometabolic Response to Blood Transfusion in Pediatric Sickle Cell Disease With Diffuse Optical Spectroscopies.
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DOI：
10.3389/fneur.2022.869117
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发表时间：
2022
影响因子：
3.4
通讯作者：
Buckley, Erin M.
中科院分区：
文献类型：
--
作者：
Lee, Seung Yup;Brothers, Rowan O.;Turrentine, Katherine B.;Quadri, Ayesha;Sathialingam, Eashani;Cowdrick, Kyle R.;Gillespie, Scott;Bai, Shasha;Goldman-Yassen, Adam E.;Joiner, Clinton H.;Brown, R. Clark;Buckley, Erin M.
关键词：
红细胞输注是镰状细胞病患者中风风险增加的常见方法。不幸的是，输血阈值需要充分稀释镰状红细胞和充分恢复氧气输送到大脑没有很好的定义。先前的研究表明输血与氧提取分数和脑血流量的减少有关，这两者在镰状病人中都异常增加。这些减少被认为是通过提高大脑对增加的代谢需求的反应能力来减轻血液代谢压力，从而减少对缺血性损伤的易感性。监测对输血的脑血代谢反应可能使输血阈值的个性化管理成为可能。漫射光谱学可能提供一种低成本、非侵入性的方法来监测这种反应。本研究招募了接受慢性输血治疗的SCD患儿。采用漫射光谱法（即漫射相关光谱法结合频域近红外光谱法）定量输血前后额叶皮层氧提取分数（OEF）、脑血容量（CBV）、脑血流量指数（CBFi）、脑氧代谢指数（cro2i）。接受每月定期输血的患者子集在随后的输血中进行测量。数据来自23例患者的35次输血。输血使中位血红蛋白水平（Hb）从9.1提高到11.7 g/dL (p < 0.001)，将中位镰状血红蛋白（HbS）从30.9%降低到21.7% （p < 0.001）。输血使OEF中位数下降5.9% (p < 0.001)， CBFi中位数下降21.2% (p = 0.020)， CBV中位数下降18.2% （p < 0.001）。cro2i与输血前比较无统计学差异（p < 0.05）。多变量分析显示结果（即OEF、CBFi、CBV和cmor2i）、Hb和人口统计学之间存在不同程度的关联。OEF、CBFi、CBV均与Hb呈负相关，而cro2i仅与年龄相关。这些结果表明，漫射光谱对输血后氧提取、血流量和血容量的预期减少很敏感。漫射光谱学可能是一种很有前途的床边工具，用于实时监测和目标导向治疗，以降低镰状细胞病卒中的风险。
Red blood cell transfusions are common in patients with sickle cell disease who are at increased risk of stroke. Unfortunately, transfusion thresholds needed to sufficiently dilute sickle red blood cells and adequately restore oxygen delivery to the brain are not well defined. Previous work has shown that transfusion is associated with a reduction in oxygen extraction fraction and cerebral blood flow, both of which are abnormally increased in sickle patients. These reductions are thought to alleviate hemometabolic stress by improving the brain's ability to respond to increased metabolic demand, thereby reducing susceptibility to ischemic injury. Monitoring the cerebral hemometabolic response to transfusion may enable individualized management of transfusion thresholds. Diffuse optical spectroscopies may present a low-cost, non-invasive means to monitor this response. In this study, children with SCD undergoing chronic transfusion therapy were recruited. Diffuse optical spectroscopies (namely, diffuse correlation spectroscopy combined with frequency domain near-infrared spectroscopy) were used to quantify oxygen extraction fraction (OEF), cerebral blood volume (CBV), an index of cerebral blood flow (CBFi), and an index of cerebral oxygen metabolism (CMRO2i) in the frontal cortex immediately before and after transfusion. A subset of patients receiving regular monthly transfusions were measured during a subsequent transfusion. Data was captured from 35 transfusions in 23 patients. Transfusion increased median blood hemoglobin levels (Hb) from 9.1 to 11.7 g/dL (p < 0.001) and decreased median sickle hemoglobin (HbS) from 30.9 to 21.7% (p < 0.001). Transfusion decreased OEF by median 5.9% (p < 0.001), CBFi by median 21.2% (p = 0.020), and CBV by median 18.2% (p < 0.001). CMRO2i did not statistically change from pre-transfusion levels (p > 0.05). Multivariable analysis revealed varying degrees of associations between outcomes (i.e., OEF, CBFi, CBV, and CMRO2i), Hb, and demographics. OEF, CBFi, and CBV were all negatively associated with Hb, while CMRO2i was only associated with age. These results demonstrate that diffuse optical spectroscopies are sensitive to the expected decreases of oxygen extraction, blood flow, and blood volume after transfusion. Diffuse optical spectroscopies may be a promising bedside tool for real-time monitoring and goal-directed therapy to reduce stroke risk for sickle cell disease.
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