以美国范德堡大学医学院的Michael R. DeBaun博士为首的研究团队进行了一项大规模横断面研究，发现了镰状红细胞型贫血患儿发生无症状性脑梗死（SCI）的危险因素。其研究结果近日发表在《血液病》（Blood）杂志上。
在完全调整的多元模型中，3个危险因素对增加发生脑梗死有显着性作用，分别是：低血红蛋白浓度，高收缩压，男性。
在仅有上述3个因素的简化模型中，它们仍然均有作用。此外，临床因素也同发生SCI的风险有关。
该研究为多中心研究，涵盖了超过800名研究对象。入选条件为被确诊为镰状红细胞贫血，年龄在5~15岁之间，且没有与缺血性疾病或癫痫发作有关的局灶性神经功能障碍病史。
研究人员发现，在814名受试对象中，存在SCI的比例为30.8%，患SCI的患儿和无SCI者的平均年龄均为9岁。而男性患儿患SCI的占58.2%，女性患儿为47.4%。患SCI患儿的血红蛋白浓度为7. 95 g/dL，而无SCI患儿为8.25 g/dL。收缩压的之差为107.31 mm Hg。
在以上这些因素中，最高收缩压（113 mm Hg或更高）与最低血红蛋白浓度（低于7.6 g/dL）与发生SCI的关系最为密切。
研究者指出，基于这些数据并不能制订预防SCI的指南，然而这些发现为进一步研究打下了基础及参考。（生物谷bioon.com）
doi: 10.1182/blood-2011-05-349621
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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).
