以美國范德堡大學(xué)醫(yī)學(xué)院的Michael R. DeBaun博士為首的研究團(tuán)隊進(jìn)行了一項大規(guī)模橫斷面研究,，發(fā)現(xiàn)了鐮狀紅細(xì)胞型貧血患兒發(fā)生無癥狀性腦梗死（SCI）的危險因素,。其研究結(jié)果近日發(fā)表在《血液病》（Blood）雜志上。
在完全調(diào)整的多元模型中,，3個危險因素對增加發(fā)生腦梗死有顯著性作用,，分別是：低血紅蛋白濃度,，高收縮壓,，男性,。
在僅有上述3個因素的簡化模型中，它們?nèi)匀痪凶饔?。此外,，臨床因素也同發(fā)生SCI的風(fēng)險有關(guān),。
該研究為多中心研究,，涵蓋了超過800名研究對象。入選條件為被確診為鐮狀紅細(xì)胞貧血,，年齡在5~15歲之間，且沒有與缺血性疾病或癲癇發(fā)作有關(guān)的局灶性神經(jīng)功能障礙病史,。
研究人員發(fā)現(xiàn),，在814名受試對象中,，存在SCI的比例為30.8%，患SCI的患兒和無SCI者的平均年齡均為9歲,。而男性患兒患SCI的占58.2%，女性患兒為47.4%,。患SCI患兒的血紅蛋白濃度為7. 95 g/dL,，而無SCI患兒為8.25 g/dL,。收縮壓的之差為107.31 mm Hg。
在以上這些因素中,，最高收縮壓（113 mm Hg或更高）與最低血紅蛋白濃度（低于7.6 g/dL）與發(fā)生SCI的關(guān)系最為密切,。
研究者指出，基于這些數(shù)據(jù)并不能制訂預(yù)防SCI的指南,，然而這些發(fā)現(xiàn)為進(jìn)一步研究打下了基礎(chǔ)及參考,。（生物谷bioon.com）
doi: 10.1182/blood-2011-05-349621
PMC:
PMID:
Associated risk factors for silent cerebral infarcts in sickle cell anemia: low baseline hemoglobin, gender and relative high systolic blood pressure
Michael R. DeBaun, Sharada A. Sarnaik, Mark J. Rodeghier, Caterina P. Minniti, Thomas H. Howard, Rathi V. Iyer, Baba Inusa, Paul T. Telfer, Melanie Kirby-Allen, Charles T. Quinn, Franoise Bernaudin, Gladstone Airewele, Gerald M. Woods, Julie Ann Panepinto, Beng Fuh, Janet K. Kwiatkowski, Allison A. King, Melissa M. Rhodes, Alexis A. Thompson, Mark E. Heiny, Rupa C. Redding-Lallinger, Fenella J. Kirkham, Hernan Sabio, Corina E. Gonzalez, Suzanne L. Saccente, Karen A. Kalinyak, John J. Strouse, Jason M. Fixler, Mae O. Gordon, J. Phillip Miller, Rebecca N. Ichord, and James F. Casella
The most common form of neurological injury in sickle cell anemia (SCA) is silent cerebral infarction (SCI). In the Silent Cerebral Infarct Multi-Center Clinical Trial (SIT Trial), we sought to identify risk factors associated with SCI. In this cross-sectional study, we evaluated the clinical history and baseline laboratory values and performed magnetic resonance imaging of the brain in participants with SCA (HbSS or HbSβ° thalassemia) between the ages of 5 and 15 years with no history of overt stroke or seizures. Neuroradiology and neurology committees adjudicated the presence of SCI. SCI were diagnosed in 30.8% (251 of 814) participants who completed all evaluations, and had valid data on all pre-specified demographic and clinical covariates. The mean age of the participants was 9.1 years, with 413 males (50.7%). In a multivariable logistic regression analysis, lower baseline hemoglobin concentration p < 0.001; higher baseline systolic blood pressure (SBP), p = 0.013; and male gender, p = .026; were statistically significantly associated with an increased risk of a SCI. Hemoglobin concentration and SBP are risk factors for SCI in children with SCA and may be therapeutic targets for decreasing the risk of SCI. This study is registered at www.clinicaltrials.gov (NCT00072761).
