【摘要】 目的观察足月新生儿缺氧缺血性脑病(HIE)时的脑代谢改变,并探讨其与临床分度及预后的关系。方法以9例无窒息的正常新生儿作为对照,对临床确诊的46例 HIE 患儿进行 MRI及氢质子 MR 波谱(~1H-MRS)检查,MRS 采用单体素及二维多体素化学位移波谱技术。46例 HIE 临床分度包括轻度25例、中度11例以及重度10例。观察 HIE 患儿 MRS 代谢物变化及其与临床分度和预后的关系。结果 (1)HIE 的典型表现为:乳酸(Lac)峰增高,谷氨酸及谷氨酰复合物α峰(GLx-α)增高及氮-乙酰天门冬氨酸(NAA)峰降低。(2)GLx-α/肌酸及磷酸肌酸(Cr)比值在对照组及 HIE 轻、中、重度组分别为0.16、0.21、0.64、1.31,GLx-α/Cr 比值在对照组及 HIE 组差异有统计学意义(t=5.01,P<0.01),且在 HIE 各组之间差异亦有统计学意义(F=63.29,P<0.05)。Lac/Cr 比值在对照组及 HIE 轻、中、重度组分别为0.12、0.14、0.19、0.26,该比值在对照组及 HIE 组差异有统计学意义(t=2.78,P<0.05),且在 HIE 各组之间差异亦有统计学意义(F=11.74,P<0.05)。GLx-α/Cr 及 Lac/Cr 比值与临床分度呈正相关性(r=0.76及0.59,P 均<0.01)。NAA/Cr 比值在 HIE重度组明显低于中、轻度组。(3)等级相关分析证明 GLx-α/Cr 及 Lac/Cr 比值与 HIE 预后呈负相关关系,尤其是 GLx-α/Cr 比值相关性更强(相关系数 r=-0.83,P<0.01),可作为评估 HIE 预后的有效指标。结论 ~1H-MRS 技术可无创观察 HIE 患儿脑代谢改变,观察脑损伤严重程度及预后评估。HIE患儿基底节区 GLx-α/Cr 比值升高提示预后不良。更多还原

【Abstract】 Objective To investigate the metabolic alterations in the brain of neonates with HIE and correlate those alterations with clinical grading and prognosis of HIE.Methods Fourty-six eases of full-term neonates diagnosed as HIE clinically were performed MRI and 1~H-MRS,9 healthy neonates without the evidence of asphyxia were studied as controls,1~H-MRS techniques included single voxel proton MRS and two dimensional muhi-voxel chemical shift spectroscopy imaging,point resolved spectroscopy sequence was used for 1~H-MRS.Metabolic changes in the spectroscopy were analyzed in neonates with HIE,and study the relationgship between MRS findings and prognosis.Results(1)The typical 1~H-MRS manifestations of full- term neonates suffering from HIE were as follows:the peaks of Lac were elevated,GLx-α were elevated and NAA were decreased.(2)GLx-α/Cr ratio in control,mild,moderate and severe HIE group was 0.16, 0.21,0.64,and 1.31,respectively.Lac/Cr ratio in control,mild,moderate and severe HIE group was 0.12,0.14,0.19,and 0.26,respectively.There was a significant difference in the ratio of GLx-α and Lac/Cr between HIE group and control group(t=5.01,P<0.01;t=2.78,P<0.05),and there was a significant difference in the ratio of GLx-α and Lac/Cr between different HIE groups(F=63.29,P<0.05; F=11.74;P<0.05).Spearman rank correlation test confirmed that the ratio of GLx-α/Cr and Lac/Cr had significant positive correlation with clinical grading of HIE(r=0.76 and 0.59,P<0.01).The ratio of NAA/Cr was much lower in severe group than those in mild-moderate group.(3)Spearman rank correlation test confirmed that the ratio of GLx-α/Cr and Lac/Cr had significant negative correlation with prognosis of HIE,especially GLx-α/Cr ratio was much more correlative(r=-0.83,P<0.01),so it could be used as an effective predicter to evaluate outcome of HIE.Conclusion 1~H-MRS is a useful tool for monitoring the brain metabolic changes noninvasively,evaluating the severity and prognosis of HIE.The higher ratio of GLx-α/Cr in basal ganglia and thalamus predicts a poor outcome in neonates with HIE.更多还原