伴有和不伴有镰状细胞特征的年轻成年人中的静默性梗死、白质完整性和氧代谢应激。
Silent Infarcts, White Matter Integrity, and Oxygen Metabolic Stress in Young Adults With and Without Sickle Cell Trait.
机构信息
Department of Neurology (Y.W., S.F., M.M.B., Y.C., H.A., J.-M.L., A.L.F.), Washington University School of Medicine, St. Louis, MO.
Division of Pediatric Neurology (K.P.G.), Washington University School of Medicine, St. Louis, MO.
出版信息
Stroke. 2022 Sep;53(9):2887-2895. doi: 10.1161/STROKEAHA.121.036567. Epub 2022 May 12.
BACKGROUND
Individuals with sickle cell anemia have heightened risk of stroke and cognitive dysfunction. Given its high prevalence globally, whether sickle cell trait (SCT) is a risk factor for neurological injury has been of interest; however, data have been limited. We hypothesized that young, healthy adults with SCT would show normal cerebrovascular structure and hemodynamic function.
METHODS
As a case-control study, young adults with (N=25, cases) and without SCT (N=24, controls) underwent brain magnetic resonance imaging to quantify brain volume, microstructural integrity (fractional anisotropy), silent cerebral infarcts (SCI), intracranial stenosis, and aneurysms. Pseudocontinuous arterial spin labeling and asymmetric spin echo sequences measured cerebral blood flow and oxygen extraction fraction, respectively, from which cerebral metabolic oxygen demand was calculated. Imaging metrics were compared between SCT cases and controls. SCI volume was correlated with baseline characteristics.
RESULTS
Compared with controls, adults with SCT demonstrated similar normalized brain volumes (SCT 0.80 versus control 0.81, =0.41), white matter fractional anisotropy (SCT 0.41 versus control 0.43, =0.37), cerebral blood flow (SCT 62.04 versus control, 61.16 mL/min/100 g, =0.67), oxygen extraction fraction (SCT 0.27 versus control 0.27, =0.31), and cerebral metabolic oxygen demand (SCT 2.71 versus control 2.70 mL/min/100 g, =0.96). One per cohort had an intracranial aneurysm. None had intracranial stenosis. The SCT cases and controls showed similar prevalence and volume of SCIs; however, in the subset of participants with SCIs, the SCT cases had greater SCI volume versus controls (0.29 versus 0.07 mL, =0.008). Of baseline characteristics, creatinine was mildly elevated in the SCT cohort (0.9 versus 0.8 mg/dL, =0.053) and correlated with SCI volume (ρ=0.49, =0.032). In the SCT cohort, SCI distribution was similar to that of young adults with sickle cell anemia.
CONCLUSIONS
Adults with SCT showed normal cerebrovascular structure and hemodynamic function. These findings suggest that healthy individuals with SCT are unlikely to be at increased risk for early or accelerated ischemic brain injury.
背景
镰状细胞贫血患者中风和认知功能障碍的风险较高。鉴于镰状细胞特征（SCT）在全球的高患病率，SCT 是否是神经损伤的危险因素一直是人们关注的问题；然而，数据有限。我们假设 SCT 年轻健康的成年人会表现出正常的脑血管结构和血液动力学功能。
方法
作为一项病例对照研究，我们对患有（N=25 例，病例组）和不患有 SCT（N=24 例，对照组）的年轻成年人进行了脑部磁共振成像，以量化脑容量、微观结构完整性（各向异性分数）、无症状性脑梗死（SCI）、颅内狭窄和动脉瘤。伪连续动脉自旋标记和不对称自旋回波序列分别测量脑血流量和氧提取分数，由此计算脑代谢氧需求。比较 SCT 病例组和对照组之间的影像学指标。SCI 体积与基线特征相关。
结果
与对照组相比，SCT 成人的脑体积正常化（SCT 0.80 与对照组 0.81，=0.41）、白质各向异性分数（SCT 0.41 与对照组 0.43，=0.37）、脑血流量（SCT 62.04 与对照组 61.16mL/min/100g，=0.67）、氧提取分数（SCT 0.27 与对照组 0.27，=0.31）和脑代谢氧需求（SCT 2.71 与对照组 2.70mL/min/100g，=0.96）相似。每一组各有一个颅内动脉瘤。均无颅内狭窄。SCT 病例组和对照组 SCI 的发生率和体积相似；然而，在 SCI 患者亚组中，SCT 病例组的 SCI 体积大于对照组（0.29 与 0.07mL，=0.008）。在 SCT 队列中，肌酐轻度升高（0.9 与 0.8mg/dL，=0.053），与 SCI 体积相关（ρ=0.49，=0.032）。在 SCT 队列中，SCI 分布与镰状细胞贫血年轻成年人相似。
结论
SCT 成年患者表现出正常的脑血管结构和血液动力学功能。这些发现表明，健康的 SCT 个体不太可能增加早期或加速缺血性脑损伤的风险。
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