足月缺氧缺血性脑病患儿^1H-MRS与新生儿神经行为测定评分的相关性

Correlation between ^1H-MRS and neonatal behavioral neurological assessment score in full-term neonates with HIE

目的探讨足月缺氧缺血性脑病（HIE）患儿^1H—MRS与NBNA评分的相关性。方法纳入足月HIE患儿101例，29例日龄≤3天、33例日龄4～7天、39例日龄8～14天；另选取同期足月健康新生儿37名作为正常对照。行常规MR及^1H—MRS检查，根据MRI表现对HIE进行分级，比较不同程度HIE患儿和正常新生儿N-乙酰天门冬氨酸（NAA）／胆碱复合物（Cho）、NAA／肌酸（Cr）及Cho／Cr差异；对HIE患儿行新生儿行为神经测定（NBNA）评分，比较不同程度HIE息儿NBNA评分差异；评价^1H—MRS指标与NBNA评分的相关性。结果≤3天重度HIE患儿，4～7天和8～14天中、重度息儿基底节NAA／Cho低于相应日龄正常新生儿（P均〈0．05），所有日龄中、重度HIE患儿基底节NAA／Cr和额叶NAA／Cho均低于相应日龄正常新生儿（P均〈0．05）；≤3天和8～14天不同程度HIE患儿间基底节NAA／Cho、4～7天不同程度HIE患儿间额叶NAA／Cho差异有统计学意义（P均〈0．05）。不同日龄重度HIE患儿NBNA评分均低于中度HIE患儿（P均〈0．05）。HIE患儿基底节NAA／Cho和NAA／Cr、额叶NAA／Cho与NBNA评分呈正相关（r=0．238，0．221，0．202；P均〈0．05）。结论HIE患儿^1H—MRs与NBNA评分具有相关性，二者结合有助于早期检出足月儿HIE及评价脑损伤严重程度。

Objective To investigate the correlation between ^1H-MRS and neonatal behavioral neurological assessment （NBNA） score in full-term neonates with hypoxic-ischemic encephalopathy （HIE）. Methods Totally 101 neonates with HIE were enrolled, among whom, 29 was ≤3 days, 33 was 4-7 days and 39 was 8-14 days. In addition, 37 healthy neonates at the same period were enrolled as normal controls. Routine MRI and ^1 H-MRS examination were performed, and HIE were graded according to MRI findings. N-acetylaspartate （NAA）/choline （Cho）, NAA/creatine （Cr） and Cho/Cr in neonates of different grades of HIE and healthy neonates were compared. NBNA was conducted on HIE neonates and compared among neonates with HIE of different grades. The correlation between ^1 H-MRS and NBNA score in full-term neonates with HIE were analyzed. Results NAA/Cho of the basal ganglia in severe HIE neonates of ≤3 days, moderate and severe HIE neonates of 4-7 days and 8--14 days were all lower than that in healthy neonates （all P〈0. 05）. NAA/Cr of the basal ganglia and NAA/Cho of the frontal lobe in all HiE neonates were lower than those in healthy neonates （all P〈 0.05）. NAA/Cho of the basal ganglia in neonates of ≤3 days and 8-14 days, and NAA/Cho of the frontal lobe in neonates of 4-7 days were found to be different between moderate and severe HIE （all P〈0. 05）. In neonates of different days of age, NBNA score of severe HIE was lower than that of moderate HIE. NAA/Cho and NAA/Cr of the basal ganglia and NAA/Cho of the frontal lobe were positively correlated with NBNA score in HIE neonates （r=0. 238, 0. 221, 0. 202, all P〈0.05）. Conclusion 1 H-MRS is correlated with NBNA score in HIE neonates, which is helpful to early de- tecting HIE in full-term neonates and evaluating the extent of brain injury.