Adekile Adekunle, Hassan Meaad, Asbeutah Akram, Al-Hinai Mohamed, Trad Omar, Farhan Nayef
Department of Pediatrics, Faculty of Medicine, Kuwait University, Safat, Kuwait.
Department of Pediatrics, College of Medicine, University of Basra, Basra, Iraq.
J Ultrasound Med. 2019 Jan;38(1):165-172. doi: 10.1002/jum.14680. Epub 2018 May 6.
Transcranial Doppler ultrasound is used to identify patients with sickle cell disease (SCD) at risk for stroke. We performed transcranial Doppler studies in patients from 4 countries in the Arabian Peninsula (Kuwait, Oman, Iraq, and United Arab Emirates) to document the prevalence of abnormal transcranial Doppler findings.
The patients were recruited from outpatient clinics and studied in a steady state. Transcranial Doppler examinations were performed with standard equipment by experienced operators. The time-averaged maximum mean velocity (TAMMV) was documented in the arteries of the circle of Willis. The hemoglobin (Hb) genotype was confirmed, and the fetal Hb level and complete blood counts were determined.
There were 415 patients in the study, aged 2 to 18 years (mean ± SD, 8.6 ± 3.5 years). None of the patients had an abnormal TAMMV (ie, > 200 cm/s), whereas only 13 (3.1%), all from Iraq, had conditional values (170-200 cm/s) in the right middle cerebral artery and 7 (1.7%) in the left middle cerebral artery. There were no consistent TAMMV differences among male and female patients or in patients with different Hb genotypes (sickle cell anemia, sickle cell β thalassemia, and sickle D). The use of hydroxyurea was associated with a lower TAMMV, whereas a blood transfusion history had no influence. Total hemoglobin, reticulocyte count, serum bilirubin, and fetal Hb values showed varying degrees of association with the TAMMV in the different vessels.
This study has demonstrated the rarity of abnormal transcranial Doppler findings among Peninsular Arab patients with SCD. The guidelines for transcranial Doppler screening in this population need further studies and recommendations.
经颅多普勒超声用于识别镰状细胞病（SCD）患者的卒中风险。我们对阿拉伯半岛4个国家（科威特、阿曼、伊拉克和阿拉伯联合酋长国）的患者进行了经颅多普勒研究，以记录经颅多普勒异常发现的患病率。
患者从门诊招募，并在稳定状态下进行研究。经颅多普勒检查由经验丰富的操作人员使用标准设备进行。记录 Willis 环动脉的时间平均最大平均流速（TAMMV）。确认血红蛋白（Hb）基因型，并测定胎儿血红蛋白水平和全血细胞计数。
本研究共纳入415例患者，年龄2至18岁（平均±标准差，8.6±3.5岁）。所有患者的TAMMV均未异常（即>200 cm/s），而只有13例（3.1%）来自伊拉克的患者右侧大脑中动脉有临界值（170 - 200 cm/s），左侧大脑中动脉有7例（1.7%）。男性和女性患者或不同Hb基因型（镰状细胞贫血、镰状细胞β地中海贫血和镰状D）的患者之间TAMMV没有一致差异。使用羟基脲与较低的TAMMV相关，而输血史没有影响。总血红蛋白、网织红细胞计数、血清胆红素和胎儿血红蛋白值在不同血管中与TAMMV显示出不同程度的相关性。
本研究表明，半岛阿拉伯SCD患者经颅多普勒异常发现罕见。该人群经颅多普勒筛查指南需要进一步研究和建议。
