Departmento de Neurologia, Psicologia e Psiquiatria, Universidade Estadual Paulista (UNESP), Botucatu, Brasil.
Departmento de Fisioterapia Aplicada, Universidade Federal Do Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brasil.
BMC Pediatr. 2022 Jun 27;22(1):368. doi: 10.1186/s12887-022-03429-5.
Sickle cell anemia (SCA) is the leading cause of childhood stroke. We aimed to evaluate whether altered cerebral flow velocities, as measured by transcranial Doppler (TCD), are associated with vaso-occlusive complications in addition to stroke in pediatric SCA patients.
We evaluated 37 children aged between 2 and 16 years with SCA who underwent screening for TCD between January 2012 and October 2018. Genotypic profiles and demographic data were collected, TCD examinations were performed during follow-up, and the presence of sickling crises was compared. Survival analyses were performed using simple frailty models, in which each predictor variable was analyzed separately in relation to the occurrence of a sickling crisis.
The variables related to sickle cell crises in the univariate analysis were peak systolic velocity (PSV) in the middle cerebral artery (MCA), hazard ratio (HR) 1.01 (1.00-1.02) p = 0.04; end-diastolic velocity (EDV) in the MCA, HR 1.02 (1.01-1.04) p = 0.01; time average mean maximum velocity (TAMMV) in the basilar artery (BA), HR 1.02 (1.00-1.04) p = 0.04; hemoglobin, HR 0.49 (0.38-0.65) p < 0.001; hematocrit, HR 0.78 (0.71-0.85) p < 0.001; leukocyte counts, HR 1.1 (1.05-1.15) p < 0.001; platelets counts, HR 0.997 (0.994-0.999) p = 0.02; and reticulocyte numbers, HR 1.14 (1.06-1.23) p < 0.001.
Our results indicate PSV and EDV in the MCA and TAMMV in the BA as markers of risk for the occurrence of sickling crises in SCA.
镰状细胞贫血（SCA）是儿童中风的主要原因。我们旨在评估经颅多普勒（TCD）测量的脑血流速度变化是否与中风以外的血管阻塞性并发症有关，此外还评估了儿科 SCA 患者。
我们评估了 2012 年 1 月至 2018 年 10 月期间接受 TCD 筛查的 37 名年龄在 2 至 16 岁之间的 SCA 儿童。收集了基因谱和人口统计学数据，在随访期间进行了 TCD 检查，并比较了镰状细胞危象的存在。使用简单的脆弱性模型进行生存分析，其中每个预测变量分别分析与镰状细胞危象发生的关系。
单变量分析中与镰状细胞危象相关的变量为大脑中动脉（MCA）的收缩期峰值速度（PSV），危险比（HR）为 1.01（1.00-1.02）p=0.04；MCA 的舒张末期速度（EDV），HR 为 1.02（1.01-1.04）p=0.01；基底动脉（BA）的平均时间最大速度（TAMMV），HR 为 1.02（1.00-1.04）p=0.04；血红蛋白，HR 为 0.49（0.38-0.65）p<0.001；红细胞压积，HR 为 0.78（0.71-0.85）p<0.001；白细胞计数，HR 为 1.1（1.05-1.15）p<0.001；血小板计数，HR 为 0.997（0.994-0.999）p=0.02；网织红细胞计数，HR 为 1.14（1.06-1.23）p<0.001。
我们的结果表明 MCA 的 PSV 和 EDV 以及 BA 的 TAMMV 是 SCA 镰状细胞危象发生的风险标志物。
