新生儿红细胞增多症与脑损伤的相关研究

Relationship between neonatal polycythemia and brain damage

目的研究新生儿红细胞增多症合并脑损伤的临床、影像学特征及其转归。方法分析2003年1月至2005年10月在我科住院的116例红细胞增多症患儿的临床特征,用颅脑超声、CT及MRI动态观察颅脑影像变化和脑血流变化,用近红外光谱分析测定脑氧合状态,并对22例中、重度病例进行3～12个月的随访。结果116例新生儿红细胞患儿中53例(45.7%)存在脑损伤,轻度31例、中度14例、重度8例。影像改变以不同范围、不同程度的缺血性损伤为主。脑损伤严重程度与红细胞增多症的持续时间、脑组织氧饱和度和脑血流异常有密切相关,经卡方检验和方差分析,显示差异有显著统计学意义(P<0.01)。而与治疗前的Hb和HCT升高程度关系不密切。随访发现中度病例(5/12)、重度病例(7/8)存在不同程度的神经系统发育异常。结论红细胞增多症容易造成脑缺血性损伤,部分病例能够影响到神经系统远期预后,以颅脑超声为主的影像检查为预后判断提供有用的方法。

Objective To investigate the clinical manifestations, imaging characteristics as well as prognosis of neonatal polyeythemia complicated with brain damage. Methods One hundred and sixteen inpatients with neonatal polyeythemia admitted to our hospital during January 2003 to October 2005 were analyzed. Their clinical manifestations were observed. Cranioeerebral ultrasonic examination （2D, 3D）, CT and MRI were employed to dynamically observe the eranioeerebral imaging variances as well as the cerebral hemodynamie variations and near infrared spectroscopy （NIR） was adopted to test the cerebral oxygenation. Twenty-two cases with moderate or severe disease were followed up for 3 to 12 months. Results Out of the 116 polyeythemie neonates, 53 cases had brain damages, of whom 31 had mild, 14 had moderate, and 8 had severe damages. Cranial imaging alterations were mostly isehemie injuries of various areas of different severity. The severity of brain damage was closely related to the duration of polyeythemia, oxygen saturation of cerebral tissues as well as cerebral hemodynamie abnormalities. Brain injury was likely to occur in those whose polyeythemia persisted for more than three days. The regional saturation of oxygen （ rSO2 ） in mild brain injury cases was found to be 52. 1% , while it was 47.1% in moderate and severe brain injury cases. Compared to the 58% as found in non-brain injury cases, the variance was found to be statistically significant （ F = 104. 466 ,P 〈 0. 01 ）. Among the cases with brain injury, cerebral hemodynamies displayed a slowdown in the blood flow velocity in the cerebral anterior artery and medium artery during the systolic phase and/or the diastolic phase. The abnormality ratio was closely related to the severity of brain injury. Through the x^2 test the variance was proved to be statistically highly significant （x^2 = 18. 889 ,P 〈0. 01 ）, however it was not correlated with the increase of the initial levels of hemoglobin （Hb） and hematoerit （HCT） （ P 〉 0. 05 ）. During the follow up, neurological developmental abnormalities of various severity were found to exist in the cases with moderate （5/12） and severe disease （7/8） , while cerebral palsy or epilepsy was not yet found. Conclusion Neonatal polyeythemia might tend to bring about a reduction in the perfusion of cerebral blood flow and damaged cerebral oxygenation metabolism which in turn might lead to cerebral isehemie injury, which in some of the moderate and severe cases might lead to long-term neurological complications. Imaging investigations especially eraniocerebral ultrasonic examination could be the practical means for the early diagnosis and evaluation of prognosis.