Intra-individual variation in blood flow velocities in cerebral arteries of children with sickle cell disease.
Intra-individual variation in blood flow velocities in cerebral arteries of children with sickle cell disease.
复制标题
镰状细胞病儿童脑动脉血流速度的个体内差异。
DOI：
10.1002/pbc.21142
复制
发表时间：
2007
影响因子：
3.2
通讯作者：
Adams,RobertJ
中科院分区：
文献类型：
--
作者：
Brambilla,DonaldJ;Miller,ScottT;Adams,RobertJ
背景患有镰状细胞病(SCD)的儿童患中风的风险较高。根据经颅多普勒(TCD)超声的测量，风险随着选定的脑动脉血流速度而增加，因此广泛推荐使用TCD对这些患者进行筛查。1995年至2002年间，4,141名2-16岁的受试者接受了经颅多普勒超声筛查，其中2,018名受试者在一项临床试验(STOP)中筛查了2,018名受试者，另一项临床试验(STOP 2)筛查了1,816名受试者，307名受试者在一项临时辅助前瞻性研究中筛查了307名患有β0-地中海贫血的纯合子SCD患者。对812例相隔6个月进行≥2检查的受试者进行分析，其中平均速度正常者242例(29.8%)，条件性血流速度正常者350例(43.1%)，速度异常者220例(27.1%)，≥速度异常者220例(27.1%)。结果TCD血流速度的受试者内标准差为14.9 cm/s，TCD血流速度的标准差为14.9 cm/s。7名受试者(0.9%)在两次检查中的血流速度有异常大且无法解释的差异(绝对差异范围为69-112厘米/秒)。结论尽管中风风险随着TCD速度异常的增加而增加，但考虑到受试者内部的相对较大的变异性，一次TCD检查通常不足以表征这一患者群体中的中风风险。儿科血癌杂志2007；49：318-322。©2007 Wiley-Liss Inc.
BackgroundChildren with sickle cell disease (SCD) are at elevated risk of stroke. Risk increases with blood flow velocity in selected cerebral arteries, as measured by transcranial Doppler (TCD) ultrasound, and use of TCD to screen these patients is widely recommended. Interpretation of TCD results should be based on knowledge of intra‐individual variation in blood flow velocity, information not currently available for sickle cell patients.ProceduresBetween 1995 and 2002, 4,141 subjects, 2–16 years old, with homozygous SCD or Sβ0‐thalasemmia and no history of stroke were screened with TCD, including 2,018 subjects screened in one clinical trial (STOP), 1,816 screened in another (STOP 2), and 307 screened in an interim ancillary prospective study. The 812 subjects with ≥2 examinations <6 months apart were selected for analysis, including 242 (29.8%) subjects with normal average velocities (i.e., <170 cm/sec), 350 (43.1%) subjects with conditional velocities (i.e., 170–199 cm/sec), and 220 (27.1%) subjects with abnormal velocities (i.e., ≥200 cm/sec). The intra‐subject standard deviation of TCD velocity was estimated from the difference between velocities at the first two interpretable examinations on each subject.ResultsAn intra‐subject standard deviation of 14.9 cm/sec was obtained. Seven (0.9%) subjects had unusually large and unexplained differences between velocities at the two examinations (range of absolute differences: 69–112 cm/sec).ConclusionsWhile stroke risk is well demonstrated to increase with increasingly abnormal TCD velocity, given the relatively large intra‐subject variability, one TCD examination is generally not sufficient to characterize stroke risk in this patient population. Pediatr Blood Cancer 2007;49:318–322. © 2007 Wiley‐Liss, Inc.