Doppler transcraniano como método de rastreio de crises de falcização em crianças com anemia falciforme
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Data
2020-08-20
Autores
Modolo, Gabriel Pinheiro
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: A anemia falciforme é a principal causa de acidente vascular cerebral (AVC) na infância. Velocidades de fluxo cerebral aumentadas avaliadas por Doppler transcraniano (DTC) podem predizer risco elevado para AVC e estão relacionadas a anemia mais grave. O objetivo do estudo foi avaliar se velocidades aferidas por DTC podem predizer complicações vasoclusivas além do AVC. Método: Incluídos no estudo pacientes entre 2 e 16 anos, com anemia falciforme, submetidos à triagem com DTC no Hospital das Clínicas da Faculdade de Medicina de Botucatu entre janeiro de 2012 e outubro de 2018. Foram coletados em prontuário eletrônico o perfil genotípico e dados demográficos dos pacientes, além dos exames de DTC realizados durante o seguimento, comparando esses parâmetros à presença de crises de falcização. Foram realizadas análises de sobrevivência por modelos de fragilidade simples em que cada variável preditora foi analisada separadamente em relação ao tempo para a ocorrência de uma crise de falcização mensurado em dias. Resultados: Foram incluídos no estudo 47 pacientes; seis foram excluídos por fazerem seguimento em outro serviço; dois por não apresentarem dados em prontuário; e dois por terem mais de 17 anos. Apresentaram relação com crises falcêmicas em análise univariada a velocidade de pico sistólico em artéria cerebral média HR 1,01 (1,00 a 1,02) p = 0,04; velocidade final diastólica em artéria cerebral média HR 1,02 (1,01 a 1,04) p = 0,01, velocidade média de fluxo em artéria basilar HR 1,02 (1,00 a 1,04) p = 0,04, hemoglobina HR 0,49 (0,38 a 0,65) p < 0,001, hematócrito HR 0,78 (0,71 a 0,85) p < 0,001, leucócitos HR 1,1 (1,05 a 1,15) p < 0,001, plaquetas HR 0,997 (0,994 a 0,999) p = 0,02 e reticulócitos HR 1,14 (1,06 a 1,23) p < 0,001. Após análise multivariada das variáveis, nenhuma apresentou relação com os desfechos. Discussão: Nossos resultados sugerem que o DTC pode ser um método eficaz de rastreio de síndromes vasoclusivas além do AVC. O fato de muitos pacientes estarem em uso de hidroxiureia ou hemotransfusão, poucos pacientes com exames de Doppler alterados e pequena amostra pode ter contribuído para perda da relação após análise multivariada. Conclusão: O exame de DTC é um método não invasivo e pode ser útil para rastreio de síndromes vasoclusivas em pacientes com anemia falciforme.
Introduction: Sickle cell anemia is the leading cause of childhood stroke. Increased cerebral flow velocities assessed by transcranial Doppler (TCD) can predict high risk for stroke and are related to more severe anemia. The aim of the study was to evaluate whether speeds measured by TCD can predict vasocclusive complications in addition to stroke. Method: Were evaluated patients between 2 and 16 years old, with sickle cell anemia, who underwent screening with TCD at the Clinical Hospital of the Botucatu Medical School between January 2012 and October 2018. The genotypic profile and demographic data were collected from electronic medical records. of the patients, in addition to the TCD exams performed during the follow-up, comparing the presence of sickling crises. Survival analyzes were performed using simple frailty models in which each predictor variable was analyzed separately in relation to the time for the occurrence of a sickling crisis measured in days. Results: We evaluated 47 patients in the period, 6 were excluded for being followed up in another service, two for not presenting data in medical records and two were over 17 in the period. Variables related to sickle-cell crises in univariate analysis were systolic peak velocity in the middle cerebral artery HR 1.01 (1.00 to 1.02) P = 0.04; final diastolic velocity in mean cerebral artery HR 1.02 (1.01 to 1.04) P = 0.01, mean flow velocity in basilar artery HR 1.02 (1.00 to 1.04) P = 0, 04, hemoglobin HR 0.49 (0.38 to 0.65) p <0.001, hematocrit HR 0.78 (0.71 to 0.85) P <0.001, leukocytes HR 1.1 (1.05 to 1, 15) p <0.001, platelets HR 0.997 (0.994 to 0.999) P = 0.02 and reticulocytes HR 1.14 (1.06 to 1.23) P <0.001. After multivariate analysis none of the evaluated variables were statistically significant. Discussion: Our results suggest that TCD may be an effective method of screening for vasocclusive syndromes in addition to stroke. The fact that many patients are using hydroxyurea or blood transfusion, few patients with altered Doppler exams and a small sample may have contributed to the loss of the relationship after multivariate analysis. Conclusion: The TCD test is a non invasive exam that can be an usefull method for screening for vasocclusive syndromes in patients with sickle cell anemia.
Introduction: Sickle cell anemia is the leading cause of childhood stroke. Increased cerebral flow velocities assessed by transcranial Doppler (TCD) can predict high risk for stroke and are related to more severe anemia. The aim of the study was to evaluate whether speeds measured by TCD can predict vasocclusive complications in addition to stroke. Method: Were evaluated patients between 2 and 16 years old, with sickle cell anemia, who underwent screening with TCD at the Clinical Hospital of the Botucatu Medical School between January 2012 and October 2018. The genotypic profile and demographic data were collected from electronic medical records. of the patients, in addition to the TCD exams performed during the follow-up, comparing the presence of sickling crises. Survival analyzes were performed using simple frailty models in which each predictor variable was analyzed separately in relation to the time for the occurrence of a sickling crisis measured in days. Results: We evaluated 47 patients in the period, 6 were excluded for being followed up in another service, two for not presenting data in medical records and two were over 17 in the period. Variables related to sickle-cell crises in univariate analysis were systolic peak velocity in the middle cerebral artery HR 1.01 (1.00 to 1.02) P = 0.04; final diastolic velocity in mean cerebral artery HR 1.02 (1.01 to 1.04) P = 0.01, mean flow velocity in basilar artery HR 1.02 (1.00 to 1.04) P = 0, 04, hemoglobin HR 0.49 (0.38 to 0.65) p <0.001, hematocrit HR 0.78 (0.71 to 0.85) P <0.001, leukocytes HR 1.1 (1.05 to 1, 15) p <0.001, platelets HR 0.997 (0.994 to 0.999) P = 0.02 and reticulocytes HR 1.14 (1.06 to 1.23) P <0.001. After multivariate analysis none of the evaluated variables were statistically significant. Discussion: Our results suggest that TCD may be an effective method of screening for vasocclusive syndromes in addition to stroke. The fact that many patients are using hydroxyurea or blood transfusion, few patients with altered Doppler exams and a small sample may have contributed to the loss of the relationship after multivariate analysis. Conclusion: The TCD test is a non invasive exam that can be an usefull method for screening for vasocclusive syndromes in patients with sickle cell anemia.
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Palavras-chave
Anemia falciforme, Acidente vascular cerebral, Doppler transcraniano, Sickle cell anemia, Stroke, Transcranial doppler