^1H MRS在足月新生儿缺氧缺血性脑病中的应用

Application value of ^1H MRS in term neonates with hypoxic-ischemic encephalopathy

目的 通过探讨氢质子磁共振波谱与足月新生儿缺氧缺血性脑病代谢变化的关系,以评估氢质子磁共振波谱在诊断足月新生儿缺氧缺血性脑病及预后的作用.方法 研究对象为30例在临床诊断为新生儿缺氧缺血性脑病的足月新生儿与7例足月正常对照儿.所有研究对象于出生13天内进行头颅氢质子磁共振波谱检查,测量右侧基底节和右侧额叶代谢产物波峰下面积值,同时记录研究对象的胎龄、性别、分娩方式、出生体重、头颅氢质子磁共振波谱检查时的日龄、新生儿缺氧缺血性脑病临床分度等资料,于其生后第3天、第7天、第14天、第28天进行新生儿行为神经评分,并对上述资料进行统计学分析.结果 ①新生儿缺氧缺血性脑病组与对照组比较,右侧基底节和右侧额叶乳酸/肌酸、N-乙酰天门冬氨酸/肌酸、谷氨酸盐和谷氨酰胺/肌酸的比值均有统计学意义（均P〈0.05）;而右侧基底节和右侧额叶肌醇/肌酸、胆碱/肌酸的比值均无统计学意义（均P〉0.05）;②新生儿缺氧缺血性脑病轻度与中重度比较,右侧基底节和右侧额叶乳酸/肌酸、N-乙酰天门冬氨酸/肌酸、谷氨酸盐和谷氨酰胺/肌酸的比值均有统计学意义（均P〈0.05）;③新生儿缺氧缺血性脑病组右侧基底节和右侧额叶乳酸/肌酸、N-乙酰天门冬氨酸/肌酸、谷氨酸盐和谷氨酰胺/肌酸的比值与临床分度有显著相关性（均P〈0.01）;④新生儿缺氧缺血性脑病组右侧基底节和右侧额叶乳酸/肌酸、N-乙酰天门冬氨酸/肌酸、谷氨酸盐和谷氨酰胺/肌酸的比值与患儿第14天新生儿行为神经评分具有显著相关性（均P〈0.01）.结论 氢质子磁共振波谱对新生儿缺氧缺血性脑病的临床诊断及短期预后评估具有重要临床意义,值得深入研究及推广.

Objective To explore relationship between ^1H magnetic resonance spectroscopy （^1H MRS） and metabolic disorders of brain of term neonates with hypoxic-ischemic encephalopathy （HIE） and to evaluate effect of ^1H MRS in diagnosis and prediction of HIE. Methods 30 term neonates with HIE and 7 normal term neonates received ^1H MRS examination within 10 days after birth. The results of ^1H MRS such as subwave crest values of metabolites in fight basal ganglia and fight frontal lobe of all neonates were recorded as well as gestational age, sex of the neonate, pattern of delivery, birth weight, day age of the neonate at 1H MRS examination and clinical degree of HIE. All the neonates received neonatal behavioral neurological assessment（NBNA） at the 3rd days, 7th days, 14th days, 28th days. The data were analyzed statistically. Results ①The results of ^1H MRS showed that in lactate/creatine（Lac/Cr）, N-acetyl aspartic acid/ereatine （NAA/ Cr） and glutamate and glutamine/creatine（Glx/Cr） ratioes in fight basal ganglia and fight frontal lobe there were statistically significant differences between HIE group and the control group （ all P 〈 0.05 ） , while there were no significant differences in myo-inocitoL/ereatine （MI/Cr） and choline/creatine（Cho/Cr） ratioes in fight basal ganglia and fight frontal lobe between the two groups （ both P 〉0.05） ; ② There were significant differences in Lac/Cr, NAA/Cr and Glx/Cr ratioes in fight basal ganglia and fight frontal lobe between mild HIE subgroup and moderate-severe subgroup in the HIE group （P 〈 0.05） ; ③Lac/Cr, NAA/Cr and Glx/Cr ratioes in fight basal ganglia and fight frontal lobe were closely related to clinical degrees of the neonates in the HIE group （ all P 〈0.01 ） ; ④Lac/Cr, NAA/Cr and Glx/ Cr ratioes in fight basal ganglia and fight frontal lobe were also closely related to NBNA scores of neonate at the 14th days after birth （ all P 〈 0.01 ）. Conclusion ^1H MRS is an useful noninvasive method to monitor brain metabolic changes of the neonates with HIE. It is of important values in diagnosing HIE and predicting short-term prognosis of the neonates.