新生儿缺氧缺血性脑损伤的磁共振成像波谱分析

Analysis of magnetic resonance imaging spectrum in neonates with hypoxic ischemic brain damage

摘要:

目的探讨新生儿缺氧缺血性脑损伤的磁共振成像波谱（MRS）分析。方法选取2013 年9 月-2016 年9 月该院确诊治疗的缺氧缺血性脑损伤新生患儿180 例，依据病情严重程度分为轻度组（n =90）、中度组（ n=50）及重度组（n =40），随访28 d，依据预后结果分为生存组（ n=150）和死亡组（n =30），所有新生患儿均给予基于磁共振成像（MRI）的MRS检测氨酸及谷氨酞复合物α峰（CLx-α）、N- 乙酰天门冬氨酸（NAA）、胆碱（Cho）、肌酸（Cr）及乳酸（Lac），采用受试者工作特征（ROC）曲线分析CLx-α/Cr 值和Lac/Cr 值对新生患儿预后的预测效能，统计分析所有新生患儿MRS 检测结果情况。结果在NAA/Cr 和NAA/Cho值方面，3 组差异有统计学意义（p <0.05）轻度组患儿高于中度组，中度组患儿高于重度组，在CLx-α/Cr 和Lac/Cr 值方面，3组差异有统计学意义（p <0.05）。轻度组患儿低于中度组，中度组患儿低于重度组，差异有统计学意义（p <0.05）；生存组患儿CLx-α/Cr 和Lac/Cr 值低于死亡组，差异有统计学意义（p <0.05）；ROC 曲线分析结果显示，CLx-α/Cr值以1.35为临界值时预测患儿死亡预后的敏感性、特异性及准确性分别为86.67%、90.00%及89.44%，Lac/Cr 以1.35 为临界值时预测患儿死亡预后的敏感性、特异性及准确性分别为83.33%、88.00%及87.22%，两者联合时预测患儿死亡预后的敏感性、特异性及准确性分别为93.33%、97.33%及97.78%，两者联合时预测患儿死亡预后的特异性、准确性高于单独CLx-α/Cr 和Lac/Cr 值时预测，差异有统计学意义（p <0.05）。结论MRS技术可有效无创检查缺氧缺血性脑损伤新生患儿脑代谢转变情况，有利于评估病情的严重程度，且联合CLx-α/Cr、Lac/Cr 值可预测患儿预后，值得临床作进一步推广。

Abstract:

Objective To discuss the application of magnetic resonance imaging spectrum (MRS) in neonatal hypoxic ischemic brain damage. Methods Totally 180 children administrated in our hospital form September 2013 to September 2016 with diagnosis of neonatal hypoxic ischemic brain damage were selected. The patients were divided into mild group (n = 90), moderate group (n = 50) and severe group ( n= 40) based on the severity. Also the patients were divided into survival group (n = 150) and death group (n = 30) based on 28 -day observation. All newborns received magnetic resonance spectroscopy of glycine and pancreatic phthalein compounds (CLx-α), N-acetyl aspartate (NAA), choline (Cho), creatine (Cr) and lactic acid (Lac).ROC curve analyses of CLx-α/Cr and Lac/Cr values were performed to predict the prognosis of newborn children. Results In the aspect of NAA/Cr and NAA/Cho values, children from the mild group had dramatically higher levels than those of the moderate group; so did the newborns from the moderate group when compared to those from the severe group. In terms of CLx-α/Cr and Lac/Cr values, the children from Nthe mild group had significantly lower levels than those of the moderate group; so did the newborns from the moderate group when compared to those from the severe group (p < 0.05). The children from the survival group experienced markedly lower levels of CLx-α/Cr and Lac/Cr when compared to those in the deceased group (p < 0.05). ROC curve analysis results showed that with the cutting edge of CLx-α/Cr value as 1.35, the sensitivity, specificity and accuracy to predict the death of children were 86.67%, 90.00% and 89.44% respectively. With the cutting edge of Lac/Cr as 1.35, the sensitivity, specificity and accuracy to predict the death of children were 83.33%, 88.00% and 87.22% respectively. Synergistic efficacy of CLx-α/Cr and Lac/Cr to predict the death was significantly higher (p < 0.05), with the sensitivity, specificity and accuracy as 93.33%, 97.33% and 97.78% respectively. Conclusions MRS technique can noninvasively monitor metabolic changes in the patients with hypoxic ischemic brain damage. Application of CLx-α/Cr combined with Lac/Cr can predict prognosis of children, it's worth further clinical promotion.