足月新生儿低血糖脑损伤临床与磁共振特征分析

Analysis of clinical and magnetic resonance features of full term newborns with hypoglycemic brain injury

目的探讨足月新生儿低血糖脑损伤病例临床特征与核磁共振(MRI)表现的相关性,为低血糖脑损伤的预防提供依据。方法回顾性分析2014年10月1日-2017年10月1日湖北省老河口市妇幼保健医院新生儿科收治的17例足月新生儿低血糖脑损伤的临床病例资料。结果吃奶差、拒奶(13/17)是低血糖脑损伤最多见的临床表现,同时多伴有反应低下,嗜睡表现(9/17),惊厥亦为最常见的临床表现之一,多为肌阵挛型惊厥(12/17),或仅表现为肢体的颤抖(7/17),偶见全身型发作(2/17);呼吸异常8例,均表现为呼吸暂停。新生儿低血糖脑损伤受累部位主要为顶枕叶皮层及皮质下白质(13/17),以双侧顶枕叶受累最为常见(9/17)、双侧枕叶次之(4/17),未见单侧病变。其次为胼胝体压部损伤较为常见(7/17),另外有4例合并额叶损伤,均表现为弥漫性脑损伤,损伤部位广泛累及多个部位。此外,低血糖脑损伤其他受累区域还包括局灶性脑室旁白质损伤、双侧视辐射、内囊后肢、半卵圆孔中心及丘脑等部位。结论 (1)生后出现低血糖临床症状(特别是神经系统症状)、发现低血糖时间较晚者,颅脑MRI均有明显的低血糖性脑损伤改变;(2)新生儿低血糖性脑损伤早期主要为磁共振弥散加权成像技术(DWI)异常高信号,晚期为T1WI低信号、T2WI高信号,损伤累及部位更多样;(3)基层临床医师对新生儿低血糖的危害性及低血糖脑损伤的认识存在不足,早期筛查,定期监测,可预防低血糖及低血糖性脑损伤的发生。

Objective To evaluate the relationship between the MRI findings and clinical characteristics in full-term infants with neonatal hypoglycemia,and provide evidence for the prevention of hypoglycemic brain injury.Methods The clinical records of 17 full- term infants with neonatal hypoglycemia who were referred to Laohekou Maternal and Child Health Hospital in Hubei Province from October 1,2014 to October 1,2017 were reviewed retrospectively.Results Feeding difficulty and refusal of feeding (13/17) were the most common clinical manifestations of hypoglycemia brain damage,accompanied by low response and drowsiness (9/17).Convulsions was also one of the most common clinical manifestations.It was mostly myoclonic convulsions (12/17),or only tremors of the limbs (7/17),occasionally systemic seizures (2/17).Eight cases of abnormal breathing.All of them showed apnea.The main affected areas of neonatal hypoglycemia brain injury were the occipital cortex and subcortical white matter (13/17).The bilateral occipital lobe involvement was the most common (9/17).The second was the bilateral occipital lobe (4/17).There was no unilateral lesions.Secondly,the damage of the corpus callosum was common (7/17).In addition,there were 4 cases of frontal lobe injury,all of which were diffused brain injury,and the injury site was extensively involved in many parts.Furthermore,other affected areas of hypoglycemic brain damage included focal ventricular white matter damage,bilateral visual radiation,hindquarters of the internal capsule,semicircular foramen,and thalamus.Conclusions ① Those who have clinical symptoms of hypoglycemia after birth (especially those with neurological symptoms) and those with long time of hypoglycemia have obvious hypoglycemic brain damage changes in brain MRI.②The early stage of neonatal hypoglycemic brain injury is mainly DWI abnormal high signal,late T1WI low signal,T2WI high signal,involving more lesions,and the damage part is diverse and complex.③The grassroot clinicians have insufficient understanding of the dangers of neonatal hypoglycemia and hypoglycemia brain damage.Early screening and regular monitoring can prevent hypoglycemia and hypoglycemia brain damage.