急性胆红素脑病和新生儿缺氧缺血性脑病的核磁学鉴别诊断

Nuclear magnetic differential diagnosis of acute bilirubin encephalopathy and neonatal hypoxic-ischemic en- cephalopathy

目的探讨新生儿缺氧缺血性脑病（HIE）与急性胆红素脑病（ABE）的MRI差别，为临床鉴别这2种疾病提供有力的客观证据。方法回顾分析2家三甲医院2010年1月至2012年1月收治住院的48例HIE新生儿和36例ABE新生儿，2组患儿均为足月儿，通过对2组患儿MRIT1WI相的分析、判读，找出2组间的差别，全部MRI影像资料均由2位副教授以上职称的神经放射学医师盲法读片，结果采用SPSS15．0统计软件进行分析。结果ABE在MRI检查中更易表现出异常（OR=29．62，95％CI：7．74～113．38），与HIE患儿比较差异有统计学意义（z2=34．636，P=0．000）；壳核信号改变多见于HIE患儿，与ABE患儿比较差异有统计学意义（疋2=4．838，P=0．028）；苍白球信号改变在ABE患儿中更易表现（OR=24．27，95％CI：7．68—76．68），与HIE患儿比较差异有统计学意义（，=36．560，P=0．000）。底丘脑信号改变在ABE患儿更易表现（OR=16．43，95％口：3．44—78．42），与HIE患儿比较差异有统计学意义（，=17．921，P=0．000）。且ABE患儿MRI苍白球、底丘脑高信号较局限、边界清楚，而HIE患儿高信号弥散、边缘模糊。结论ABE患儿MRI在苍白球、底丘脑更易表现为高信号，HIE患儿在壳核更易表现为高信号；ABE所致损伤较为局限，损伤区域边界清晰，HIE损伤较为弥散，边界不清楚。

Objective To provide more objective evidence for clinical differential diagnosis of the neonatal hy- poxic-ischemic eneephalopathy（HIE） and acute bilirubin encephalopathy（ABE） by reviewing the magnetic resonance imaging differences between them. Methods The MRI findings along with T1WI characteristics in 48 neonates with HIE and in 36 neonates with ABE in two Grade llI Class A hospitals between Jan. 2010 and Jan. 2012 were retrospec- tively reviewed. All of the MRI imaging data were read again by 2 professor neuroradiologist from these hospital by blind method, and the results were analyzed by the SPSS 15.0 statistical analysis software. Results The ABE in the MRI ex- amination exhibited more abnormalities （ OR = 29. 62,95 % CI： 7.74 - 113.38 ）, the difference was statistically signifi- cant（xz = 34. 636,P = 0. 000） ; Putamen signals changes were more observed clearly in the HIE, and compared with those in ABE patients, the difference was statistically significant （X2 = 4. 838, P = 0.028 ） ;the performance of the globus pallidus signals changes in ABE neonates were more observed （OR = 24. 27,95% CI： 7.68 -76.68 ）, and compared with those in HIE neonates, the difference was statistically significant （X2 = 36. 560, P = 0. 000 ）. Subthalamie signal changes were found most in ABE neonates （ OR = 16. 43,95 % CI：3.44 -78.42 ）, the difference was statistically signifi- cant（x： = 17. 921 ,P =0.000）. And the ABE globus pallidus ,subthalamie high signal was localized,with a clear boun- dary, and high signal intensity on HIE diffusion, and edge blur. Conclusions The globus pallidus, subthalamie of neo- nates with ABE more easily demonstrated high signal, the putamen in neonates with HIE more easily demonstrated high signal;injury induced by ABE is limited, the damage area with clear boundary, HIE damage is more dispersed, the boundary is not clear.