Nocturnal hypoxaemia and central-nervous-system events in sickle-cell disease
Nocturnal hypoxaemia and central-nervous-system events in sickle-cell disease
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DOI：
10.1016/s0140-6736(00)04821-2
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发表时间：
2001-05-26
期刊：
影响因子：
168.9
通讯作者：
Evans, JPM
中科院分区：
文献类型：
--
作者：
Kirkham, FJ;Hewes, DKM;Evans, JPM
背景镰状细胞病常见的中枢神经系统事件，包括中风、短暂性脑缺血发作和癫痫发作。在经颅多普勒超声上，可以通过颈内动脉或大脑中动脉的高速运动来预测中风。我们验证了夜间低氧血症可以比临床或血液学特征或经颅多普勒超声更好地预测中枢神经系统事件的假设。方法采用经颅多谱勒和隔夜脉搏血氧仪对95例无中风病史的镰状细胞病患者进行筛查。平均随访6.01(0.11-8.54)年，发现19例患者有中枢神经系统事件(6例缺血性中风，1例出血性中风，8例短暂性脑缺血发作，4例癫痫发作)。平均夜间血氧饱和度([SaO(2)]危险比0.82每增加1%[95%可信区间0.71~0.93]；p=0.003)和较高的颈内动脉或大脑中动脉血流速度(每增加1 cm/S[1.004~1.03]；p=0.009)与中枢神经系统事件发生的时间独立相关。在考虑了平均动脉血氧饱和度、动脉血流速度和血红蛋白病后，高血红蛋白浓度也与中枢神经系统事件的风险增加相关(1.7pg/dL，[1.18-2.43]；p=0.004)。提示阻塞性睡眠呼吸暂停的低氧血症并不能预测中枢神经系统事件，尽管脑梗塞范围广泛且临床上有重要影响，但腺体扁桃体切除术似乎没有作用。对于镰状细胞病的中枢神经系统事件的一级预防，解释筛查和适当处理夜间低氧血症可能是一种安全有效的替代预防措施。
Background Central-nervous-system (CNS) events, including strokes, transient ischaemic attacks, and seizures are common in sickle-cell disease. Stroke can be predicted by high velocities in the internal-carotid or middle-cerebral arteries on transcranial doppler ultrasonography. We tested the hypothesis that nocturnal hypoxaemia can predict CNS events better than clinical or haematological features, or transcranial doppler sonography.Methods We screened 95 hospital-based patients with sickle-cell disease (median age 7.7 years [range 1.0-23.1]), but without previous stroke, with transcranial doppler and overnight pulse oximetry. Follow-up continued for a median of 6.01(0.11-8.54) years.Findings 19 patients had CNS events (six ischaemic and one haemorrhagic stroke, eight transient ischaemic attacks, and four seizures). Mean overnight oxygen saturation ([SaO(2)] hazard ratio 0.82 per 1% increase [95% CI 0.71-0.93]; p=0.003) and higher internat-carotid or middle-cerebral artery velocity (1.02 for every increase of 1 cm/s [1.004-1.03]; p=0.009) were independently associated with time to CNS event. After accounting for mean SaO(2), artery velocity, and haemoglobinopathy, high haemoglobin concentration was also associated with an increased risk of CNS event (1.7 per g/dL, [1.18-2.43]; p=0.004). Dips suggestive of obstructive sleep apnoea did not predict CNS events, and adenotonsillectomy seemed to have no effect, although the CI were wide and clinically important effects cannot be excluded.Interpretation Screening for, and appropriate management of, nocturnal hypoxaemia might be a safe and effective alternative to prophylactic blood transfusion for primary prevention of CNS events in sickle-cell disease.