Discontinuing prophylactic transfusions increases the risk of silent brain infarction in children with sickle cell disease: data from STOP II
Discontinuing prophylactic transfusions increases the risk of silent brain infarction in children with sickle cell disease: data from STOP II
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DOI：
10.1182/blood-2010-12-326298
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发表时间：
2011-07-28
期刊：
影响因子：
20.3
通讯作者：
Adams, Robert J.
中科院分区：
文献类型：
--
作者：
Abboud, Miguel R.;Yim, Eunsil;Adams, Robert J.
在 STOP II 试验中，患有镰状细胞病 (SCD) 的高危儿童停止预防性输血导致经颅多普勒 (TCD) 超声检查和中风的血流速度异常恢复率很高。我们分析了 STOP II 的数据，以确定停止输血对磁共振成像 (MRI) 上无症状脑梗塞发生或进展的影响。研究开始时，79 名患者中有 21 名 (27%) 有无症状梗塞的证据。在研究开始时，脑部 MRI 正常或无症状梗塞的患者之间的基线特征没有统计学上的显着差异。研究结束时，继续输血组 37 名患者中有 3 名 (8.1%) 出现新的脑部 MRI 病变，而停止输血组 40 名患者中有 11 名 (27.5%) (P = 0.03)。继续输血组的病灶总数基本保持不变，从25个减少到24个，而停止输血组的病灶总数从27个增加到45个。因此，患有 SCD 和异常 TCD 的儿童恢复低风险后停止输血会增加无症状脑梗死的风险。结合 STOP 的数据，这些发现表明，输血可以预防 SCD 和 TCD 异常但 MRA 正常的患者发生无症状梗塞。 （血。2011；118(4):894-898）
In the STOP II trial, discontinuation of prophylactic transfusions in high risk children with sickle cell disease (SCD) resulted in a high rate of reversion to abnormal blood-flow velocities on transcranial Doppler (TCD) ultrasonography and strokes. We analyzed data from STOP II to determine the effect of discontinuing transfusions on the development or progression of silent brain infarcts on magnetic resonance imaging (MRI). At study entry, 21 of 79 (27%) patients had evidence of silent infarcts. There were no statistically significant differences in baseline characteristics between patients with normal brain MRI or silent infarcts at study entry. At study end, 3 of 37 (8.1%) patients in the continued-transfusion group developed new brain MRI lesions compared with 11 of 40 (27.5%) in the transfusion-halted group (P = .03). The total number of lesions remained essentially unchanged decreasing from 25 to 24 in the continued-transfusion group while increasing from 27 to 45 in transfusion-halted patients. Thus, discontinuation of transfusions in children with SCD and abnormal TCD who revert to low-risk increases the risk of silent brain infarction. Together with data from STOP, these findings demonstrate that transfusions prevent the development of silent infarcts in patients with SCD and abnormal TCD but normal MRA. (Blood. 2011;118(4):894-898)