Radiology:镰状细胞性贫血患儿下肢血流动力学的多普勒超声表现

2022-08-15 shaosai MedSci原创

现阶段,静脉瘀滞被认为是SCA患者腿部溃疡发展的一个起始事件。然而,SCA患者的静脉造影研究未能显示静脉功能不全,正如其他原因造成的瘀血性溃疡一样,使得SCA患者的静脉瘀血发病机制不明确。

镰状细胞疾病由芝加哥医生James B. Herrick在1910年首次报告,其最严重的形式是镰状细胞性贫血(SCA),父母双方都有缺陷的血红蛋白S(Hb S)基因,导致Hb S同型性(Hb SS),是美国最常见的遗传性血液疾病。

患有SCA的病人很容易出现慢性腿部溃疡,这些溃疡十分疼痛,且复发率高。因此,积极预防溃疡是SCA患者常规管理中的一个重要过程。然而,为了制定有效的溃疡预防措施,必须了解导致SCA腿部溃疡的病理生理机制。

现阶段静脉瘀滞被认为是SCA患者腿部溃疡发展的一个起始事件。然而,SCA患者的静脉造影研究未能显示静脉功能不全,正如其他原因造成的瘀血性溃疡一样,使得SCA患者的静脉瘀血发病机制不明确。

近日,发表Radiology杂志的一项研究利用多普勒超声评估了SCA患儿下肢的血流动力学模式和周围动脉的通畅性,并通过踝臂指数测量来诊断闭塞性周围动脉疾病,为临床提供了一种适合儿童的安全和无痛的影像学诊断工具。

研究为一项在2020年7月-2021年5月之间进行的前瞻性研究。纳入了两组参与者:SCA和健康对照的儿童。使用彩色多普勒和光谱多普勒对远端前部和后胫骨动脉进行了评估。比较了SCA和健康对照儿童之间的血流动力学值,其统计显着性设定为p <.05水平。

评估了45名SCA患者(平均年龄,9.5岁±3.7 [SD]; 26名男孩)和45个健康对照(平均年龄,9.3岁,9.3岁±3.8; 25 Boys)。与健康参与者相比,SCA患者的峰值收缩期速度,末期速度和血容量的速度和血容量较高(所有12个测量值的P <.001)。与至少一个前胫骨前动脉中的健康对照相比,SCA儿童的电阻指数和脉动指数值也较低。在SCA的参与者中仅观察到单相光谱模式。SCA的参与者(平均值为1.09±0.08)和健康参与者(平均1.06±0.02)的参与者的踝臂指数在正常范围内。


 一个患有镰状细胞贫血的10岁男孩的腿部照片。他的右腿周围的皮肤呈暗色(圆圈)。镰状细胞性贫血患者在腿部溃疡之前可能会有皮肤变化,如变黑。还应注意他的左脚底因慢性贫血而变得苍白

综上所述,与健康对照组相比,镰状细胞性贫血(SCA)患儿在多普勒测量时会有异常的血流动力学特征。如果发现可预测溃疡的基线多普勒模式并确定潜在的风险因素,为临床早期识别及干预提供了参考依据。

 

原文出处:

Olurotimi O Komolafe,Victor A Adetiloye,Oluwagbemiga O Ayoola,et al.Abnormal Lower Extremity Hemodynamics at Doppler US in Children with Sickle Cell Anemia.DOI:10.1148/radiol.211941

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