American University of Beirut Medical Center, Beirut, Lebanon.
Blood. 2011 Jul 28;118(4):894-8. doi: 10.1182/blood-2010-12-326298. Epub 2011 Jun 1.
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.
在 STOP II 试验中，停止对镰状细胞病（SCD）高危儿童的预防性输血导致经颅多普勒（TCD）超声检查血流速度异常和中风的逆转率很高。我们分析了 STOP II 的数据，以确定停止输血对磁共振成像（MRI）上无症状性脑梗死的发展或进展的影响。在研究开始时，79 名患者中有 21 名（27%）有无症状性梗死的证据。在研究开始时，MRI 正常或有无症状性梗死的患者在基线特征上没有统计学差异。在研究结束时，与继续输血组的 37 名患者中的 3 名（8.1%）相比，中断输血组中有 11 名患者（27.5%）出现新的脑 MRI 病变（P =.03）。继续输血组的病变总数基本不变，从 25 个减少到 24 个，而中断输血组则从 27 个增加到 45 个。因此，在 TCD 异常但 MRA 正常的 SCD 患儿中停止输血会增加无症状性脑梗死的风险。结合 STOP 的数据，这些发现表明输血可预防 TCD 异常但 MRA 正常的 SCD 患者发生无症状性梗死。
