Silent cerebral infarcts occur despite regular blood transfusion therapy after first strokes in children with sickle cell disease
Silent cerebral infarcts occur despite regular blood transfusion therapy after first strokes in children with sickle cell disease
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DOI：
10.1182/blood-2010-01-261123
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发表时间：
2011-01-20
期刊：
影响因子：
20.3
通讯作者：
DeBaun, Michael R.
中科院分区：
文献类型：
--
作者：
Hulbert, Monica L.;McKinstry, Robert C.;DeBaun, Michael R.
患有镰状细胞病（SCD）和中风的儿童接受输血治疗以进行中风二级预防；尽管如此，大约 20% 的人会经历第二次明显的中风。考虑到第二次明显中风的发生率和无症状脑梗塞的临床意义，我们检验了以下假设：无症状脑梗塞发生在为二级中风预防而输血的 SCD 儿童中。一项前瞻性队列研究在 7 个学术中心招募了患有 SCD 和明显中风的儿童。大约每 1 至 2 年安排一次脑部磁共振成像和磁共振血管造影；研究由神经放射学家小组进行了审查。资格标准包括定期输血治疗。其中包括四十名儿童；平均输血前血红蛋白 S 浓度为 29%。 45%（40 名儿童中的 18 名）在接受长期输血治疗时发生进行性脑梗塞； 7 人出现第二次明显中风，11 人出现新的无症状脑梗塞。脑血管病变恶化与新发脑梗死相关（明显或无症状；相对风险 = 12.7；95% 置信区间，2.65-60.5，P = .001）。接受定期输血治疗的患有 SCD 和明显中风的儿童出现无症状脑梗塞的几率比以前认识到的要高。患有 SCD 的儿童需要额外的治疗来进行二级卒中预防。 (血液.2011;117(3):772-779)
Children with sickle cell disease (SCD) and strokes receive blood transfusion therapy for secondary stroke prevention; despite this, approximately 20% experience second overt strokes. Given this rate of second overt strokes and the clinical significance of silent cerebral infarcts, we tested the hypothesis that silent cerebral infarcts occur among children with SCD being transfused for secondary stroke prevention. A prospective cohort enrolled children with SCD and overt strokes at 7 academic centers. Magnetic resonance imaging and magnetic resonance angiography of the brain were scheduled approximately every 1 to 2 years; studies were reviewed by a panel of neuroradiologists. Eligibility criteria included regularly scheduled blood transfusion therapy. Forty children were included; mean pretransfusion hemoglobin S concentration was 29%. Progressive cerebral infarcts occurred in 45% (18 of 40 children) while receiving chronic blood transfusion therapy; 7 had second overt strokes and 11 had new silent cerebral infarcts. Worsening cerebral vasculopathy was associated with new cerebral infarction (overt or silent; relative risk = 12.7; 95% confidence interval, 2.65-60.5, P = .001). Children with SCD and overt strokes receiving regular blood transfusion therapy experience silent cerebral infarcts at a higher rate than previously recognized. Additional therapies are needed for secondary stroke prevention in children with SCD. (Blood.2011;117(3):772-779)