Hemominas Foundation, Belo Horizonte, Brazil.
Pediatr Blood Cancer. 2011 Jan;56(1):116-21. doi: 10.1002/pbc.22680. Epub 2010 Oct 14.
Transcranial Doppler ultrasonography (TCD) is an important way of detecting risk of ischemic stroke in children with sickle cell anemia.
A random sample of 262 FS-hemoglobin children from a newborn screening inception cohort in Brazil (1998-2005) was followed up to May 2009. Pulsed TCD followed STOP protocol. Children with mean blood flow velocity < 170 cm/sec in cerebral arteries were classified as low risk; between 170 and 184, low conditional risk; between 185 and 199, high conditional risk; and ≥ 200, high risk.
Median age, 6.2 years (2-11.2 years); 147 female; 13 children (5%) had ischemic stroke prior to TCD; 186/249 (74.7%) were classified as low risk; 19 (7.6%) as low conditional; 7 (2.8%) as high conditional; and 8 (3.2%) as high risk; inadequate tests, 11.6%. The probability of ischemic stroke at 10 years was 8.3% (SEM 2.3%); of stroke or high-risk TCD 15.6% (3.5%). Children with stroke or altered TCD (conditional and high risk) were compared to children with normal examinations. They were younger (P = 0.03), with lower hemoglobin (P = 0.003), higher leukocytosis (P = 0.015), and higher reticulocytosis (P < 0.001). Episodes per year of acute chest syndrome were also higher in that group, but not significantly (P = 0.09). Reticulocytosis remained the only significant variable upon multivariate analysis (P = 0.004). Basilar and middle cerebral artery velocities were significantly correlated (R = 0.55; P < 0.001).
Probability of stroke was similar to international reports; of belonging to high-risk group, lower. High-reticulocyte count was the most important factor associated with cerebrovascular disease. Basilar artery velocity > 130 cm/sec seems to be an indirect sign of an underlying cerebrovascular disease.
经颅多普勒超声（TCD）是检测镰状细胞贫血儿童缺血性中风风险的重要方法。
巴西（1998-2005 年）新生儿筛查队列中随机抽取 262 例 FS-血红蛋白患儿进行随访，随访至 2009 年 5 月。采用脉冲 TCD 检测，遵循 STOP 方案。大脑动脉平均血流速度＜170cm/sec 的患儿被归类为低危；170-184cm/sec 的为低条件风险；185-199cm/sec 的为高条件风险；≥200cm/sec 的为高危。
中位年龄 6.2 岁（2-11.2 岁）；女性 147 例；13 例（5%）患儿在 TCD 前发生缺血性中风；249 例患儿中，186 例（74.7%）为低危；19 例（7.6%）为低条件风险；7 例（2.8%）为高条件风险；8 例（3.2%）为高危；检测不充分者占 11.6%。10 年缺血性中风的概率为 8.3%（SEM 2.3%）；中风或高危 TCD 为 15.6%（3.5%）。与正常检查的患儿相比，发生中风或 TCD 改变（条件和高危）的患儿年龄更小（P = 0.03），血红蛋白更低（P = 0.003），白细胞计数更高（P = 0.015），网织红细胞计数更高（P < 0.001）。急性胸部综合征的年发作次数也更高，但无显著差异（P = 0.09）。多元分析显示，仅网织红细胞计数为唯一显著变量（P = 0.004）。基底动脉和大脑中动脉的速度呈显著相关（R = 0.55；P < 0.001）。
中风概率与国际报道相似；高危组的比例较低。高网织红细胞计数是与脑血管疾病相关的最重要因素。基底动脉速度＞130cm/sec 似乎是潜在脑血管疾病的间接征象。
