儿童病毒性脑炎的氢质子磁共振波谱分析与临床应用研究

The Application of Proton Magnetic Resonance Spectroscopy in Diagnosing Viral Encephalitis in Children

目的:探讨儿童病毒性脑炎时氢质子磁共振波谱(1H-MRS)的特点及其临床意义。方法:回顾性分析经我院儿科确诊的40例儿童病毒性脑炎患者(脑炎组)的临床资料,按格拉斯哥昏迷评分(GCS)分为重型亚组18例和轻型亚组22例,并和对照组20例患儿均行MRI扫描,以颞叶、基底核及病灶区(MRI检出信号异常处)为感兴趣区(ROI)进行1H-MRS分析。结果:病灶区1H-MRS结果均有异常,表现为乙酰天门冬氨酸盐(NAA)下降、胆碱(Cho)升高,NAA/Cho降低,且病情越重,该比值降低越明显。在颞叶或基底核,脑炎组有34例NAA/Cho<1,其中包括所有重型患儿和16例轻型患儿,且重型亚组NAA/Cho比值更低,对照组NAA/Cho>1,3组之间比较差异有统计学意义(F=76.34,P<0.01)。结论:儿童病毒性脑炎时NAA/Cho<1是判断脑损伤的一个很有意义的参考指标,1H-MRS和MRI相结合,对病毒性脑炎的早期诊断、病情的严重性评估具有重要价值。

Objective： To investigate the characteristics of proton magnetic resonance spectroscopy （^1H-MRS） in children with viral encephalitis and to evaluate its clinical application. Methods：The clinical data of 40 children with viral encephalitis diabnosed clinically were analyzed retrospectively. The 40 cases were divided into two groups according to the Glasgow Coma Scale （GCS） ： 18 severe cases with scores of 3-8, and 22 mild cases with scores of 9-15. Another 20 normal children were enrolled as controls. All the children have undergone ^1H-MRS imaging in the temporal lobes,basal ganglia, and the lesion areas. Results：In all the lesion areas,^1H-MRS showed a decreased N-aeetyl aspartate （NAA） and an increased Choline （Cho） , yielding a drop of the NAA/Cho ratio. The NAA/Cho ratio negatively correlated with the severity of the disease. In addition, in the temporal lobes and basal ganglia, the NAA/Cho ratios of all 34 cases with viral encephalitis were less than （ 1 whereas the ratios were larger than 1 in the controls （F=76.34,P〈0.01）. Conclusion：The NAA/Cho ratio may be a valuable marker for neuronal damage in diagnosing viral encephalitis. In combination with MRI, ^1H-MRS could be useful in the early diagnosis of viral encephalitis in children and in assessing the severity.