Martino Suella, Turki Rym Chouk, Zouiti Fouzia, Fort Romain, Pakdaman Sadaf, Forté Stéphanie, Menouche Dehbia, Calvet David, Rupp Thomas, Pirenne France, Bartolucci Pablo
Sickle Cell Referral Center, Department of Internal Medicine, Henri Mondor University Hospital, UPEC, APHP, 94000 Creteil, France.
Etablissement Français du Sang, Île-de-France Mondor, 94000 Creteil, France.
J Clin Med. 2023 Feb 5;12(4):1256. doi: 10.3390/jcm12041256.
Cerebral vasculopathy can induce chronic cerebral hypoperfusion leading to stroke in patients with sickle cell disease (SCD) and is treated by blood exchange transfusion (BET). However, no prospective clinical study has demonstrated the benefit of BET in adults with SCD and cerebral vasculopathy. Near Infrared Spectroscopy (NIRS) is a recent non-invasive method complementary to Magnetic Resonance Imaging (MRI). We evaluated cerebral perfusion using NIRS during erythracytapheresis in patients with SCD with and without steno-occlusive arterial disease.
We conducted a monocentric, prospective study in 16 adults with SCD undergoing erythracytapheresis in 2014. Among them, 10 had cerebral steno-occlusive arterial disease. NIRS measured the relative amounts of oxyhemoglobin (OxyHb), deoxyhemoglobin (DeoxyHb) and total hemoglobin (Total Hb) in brain tissue and in muscle.
In cerebral hemispheres associated with steno-occlusive arterial disease, we observed a significant increase of OxyHb and Total Hb during BET, without modification of DeoxyHb.
Using NIRS during BET showed that BET improves cerebral perfusion in adult patients with SCD with cerebral vasculopathy.
脑血管病变可导致镰状细胞病（SCD）患者发生慢性脑灌注不足，进而引发中风，血液置换输血（BET）是其治疗方法。然而，尚无前瞻性临床研究证明BET对患有脑血管病变的成年SCD患者有益。近红外光谱（NIRS）是一种新近出现的、可作为磁共振成像（MRI）补充手段的非侵入性方法。我们在有或无动脉狭窄闭塞性疾病的SCD患者进行红细胞单采术期间，使用NIRS评估脑灌注情况。
2014年，我们对16例接受红细胞单采术的成年SCD患者开展了一项单中心前瞻性研究。其中，10例患有脑动脉狭窄闭塞性疾病。NIRS测量了脑组织和肌肉中氧合血红蛋白（OxyHb）、脱氧血红蛋白（DeoxyHb）和总血红蛋白（Total Hb）的相对含量。
在与动脉狭窄闭塞性疾病相关的大脑半球中，我们观察到在BET期间OxyHb和Total Hb显著增加，而DeoxyHb无变化。
在BET期间使用NIRS表明，BET可改善患有脑血管病变的成年SCD患者的脑灌注。
