新鲜红细胞输注与标准红细胞相比并不能改善危重患儿的预后
作者：
小柯机器人 发布时间：2019/12/16 17:52:13
新鲜红细胞与标准红细胞输血对危重患儿多器官功能障碍综合征的影响，这一成果由美国圣路易斯华盛顿大学医学院Philip C. Spinella联合加拿大拉瓦尔大学 Alexis F. Turgeon研究小组取得。 这一研究成果于2019年12月10日发表在国际顶尖学术期刊《美国医学会杂志》上。
目前，关于红细胞储存时限对危重儿童的临床后果仍缺乏大规模随机临床试验的验证。
2014年2月至2018年11月，研究组对危重儿童输血时限进行了一项国际性、多中心、单盲、随机临床试验，在50个三级医疗中心进行。参与者的年龄为3天至16岁，均在进入ICU7天内进行第一次输血。共招募了1461名符合条件的患儿，中位年龄为1.8岁，将其随机分组，其中728名输注新鲜红细胞（新鲜组），733名输注标准红细胞（标准组）。新鲜组的中位储藏时间为5天，标准组为18天。
治疗28天后，新鲜组中新发或进行性多器官功能障碍综合征的发生率为20.2%，标准组为18.2%，差异不显著。新鲜组中脓毒症的患病率为25.8%，标准组为25.3%。新鲜组中急性呼吸窘迫综合症的患病率为6.6%，标准组为4.8%。新鲜组ICU死亡率为4.5%，标准组为3.5%。
总之，对于危重患儿，输注新鲜红细胞与标准红细胞相比，并不能降低新发或进行性多器官功能障碍综合征以及死亡的发生率。
附：英文原文
Title: Effect of Fresh vs Standard-issue Red Blood Cell Transfusions on Multiple Organ Dysfunction Syndrome in Critically Ill Pediatric Patients: A Randomized Clinical Trial
Author: Philip C. Spinella, Marisa Tucci, Dean A. Fergusson, Jacques Lacroix, Paul C. Hébert, Stéphane Leteurtre, Kenneth B. Schechtman, Allan Doctor, Robert A. Berg, Tina Bockelmann, J. Jaime Caro, Fabrizio Chiusolo, Lucy Clayton, Jill M. Cholette, Gonzalo Garcia Guerra, Cassandra D. Josephson, Kusum Menon, Jennifer A. Muszynski, Marianne E. Nellis, Amrita Sarpal, Stephanie Schafer, Marie E. Steiner, Alexis F. Turgeon
Issue&Volume: 2019/12/10
Abstract:
Importance Hereditary transthyretin (TTR) amyloid cardiomyopathy (hATTR-CM) due to the TTR V122I variant is an autosomal-dominant disorder that causes heart failure in elderly individuals of African ancestry. The clinical associations of carrying the variant, its effect in other African ancestry populations including Hispanic/Latino individuals, and the rates of achieving a clinical diagnosis in carriers are unknown.
Objective To assess the association between the TTR V122I variant and heart failure and identify rates of hATTR-CM diagnosis among carriers with heart failure.
Design, Setting, and Participants Cross-sectional analysis of carriers and noncarriers of TTR V122I of African ancestry aged 50 years or older enrolled in the Penn Medicine Biobank between 2008 and 2017 using electronic health record data from 1996 to 2017. Case-control study in participants of African and Hispanic/Latino ancestry with and without heart failure in the Mount Sinai BioMe Biobank enrolled between 2007 and 2015 using electronic health record data from 2007 to 2018.
Exposures TTR V122I carrier status.
Main Outcomes and Measures The primary outcome was prevalent heart failure. The rate of diagnosis with hATTR-CM among TTR V122I carriers with heart failure was measured.
Results The cross-sectional cohort included 3724 individuals of African ancestry with a median age of 64 years (interquartile range, 57-71); 1755 (47%) were male, 2896 (78%) had a diagnosis of hypertension, and 753 (20%) had a history of myocardial infarction or coronary revascularization. There were 116 TTR V122I carriers (3.1%); 1121 participants (30%) had heart failure. The case-control study consisted of 2307 individuals of African ancestry and 3663 Hispanic/Latino individuals; the median age was 73 years (interquartile range, 68-80), 2271 (38%) were male, 4709 (79%) had a diagnosis of hypertension, and 1008 (17%) had a history of myocardial infarction or coronary revascularization. There were 1376 cases of heart failure. TTR V122I was associated with higher rates of heart failure (cross-sectional cohort: n?=?51/116 TTR V122I carriers [44%], n?=?1070/3608 noncarriers [30%], adjusted odds ratio, 1.7 [95% CI, 1.2-2.4], P?=?.006; case-control study: n?=?36/1376 heart failure cases [2.6%], n?=?82/4594 controls [1.8%], adjusted odds ratio, 1.8 [95% CI, 1.2-2.7], P?=?.008). Ten of 92 TTR V122I carriers with heart failure (11%) were diagnosed as having hATTR-CM; the median time from onset of symptoms to clinical diagnosis was 3 years.
Conclusions and Relevance Among individuals of African or Hispanic/Latino ancestry enrolled in 2 academic medical center–based biobanks, the TTR V122I genetic variant was significantly associated with heart failure.
DOI: 10.1001/jama.2019.17478
Source: https://jamanetwork.com/journals/jama/article-abstract/2757226
