MRI对亚临床胆红素脑损伤诊断的价值

Diagnostic value of MRI in subclinical bilirubin brain damage

目的:探讨MRI对亚临床胆红素脑损伤诊断的价值。方法:回顾性分析2012年1月至2014年12月本院收治的130例高胆红素血症但未达到胆红素脑病诊断标准(亚临床胆红素脑损伤)的新生儿的临床资料,按MRI有无发现苍白球对称性T1W1高信号改变分为脑损伤组(52例)及非脑损伤组(78例),比较两组胆红素水平、头颅MRI表现、神经发育情况。结果:脑损伤组的血清总胆红素、间接胆红素、直接胆红素等指标均显著高于非脑损伤组(P<0.01);脑损伤组例数随着血清总胆红素水平升高而增加,STB≥513μmol/L者占88.5%,明显高于非脑损伤组(P<0.01);治疗后两组患儿贝利婴幼儿发育量表MDI、PDI等评估指标均有提高,而脑损伤组MDI、PDI等指标水平提升幅度显著高于非脑损伤组(P<0.01),两组比较差异无统计学意义(P>0.05);治疗后脑损伤组MDI、PDI值≥85分者分别占90.4%、86.5%,显著高于非脑损伤组(P<0.05)。结论:血清胆红素浓度与脑损伤密切相关;血清总胆红素513μmol/L可作为引起亚临床胆红素脑损伤的阈值。对达到亚临床胆红素脑损伤阈值的新生儿应及时进行早期干预,以避免亚临床胆红素脑损伤的出现。头颅MRI检查可及时发现亚临床胆红素脑损伤,早期干预治疗可改善其预后。

Objective： To investigate the diagnostic value of magnetic resonance imaging（ MRI） in subclinical bilirubin brain damage. Methods： A retrospective analysis was conducted of clinical data from 130 newborns with hyperbilirubinemia but not fulfilling the diagnostic criteria for bilirubin encephalopathy（ subclinical bilirubin brain damage） in our hospital between January 2012 and December 2014. According to the presence of symmetric high signal at globus pallidus on T1W1-weighted MRI,the newborns were devided into brain injury group（ n = 52） and non-brain injury group（ n = 78）. The two groups were compared for bilirubin levels,brain MRI findings,and nerve development. Results： The levels of serum total bilirubin（ STB）,indirect bilirubin and direct bilirubin were significantly higher in the brain injury group than those in the nonbrain injury group（ P〈0. 01）. The number of newborns with brain injury increased with higher total serum bilirubin levels. 88. 5% of all brain injury cases having STB≥513μmol / L,and this rate was significantly higher than as found for the non-brain injury group（ P〈0. 01）. After treatment,the values of PDI and MDI in Bailey Infant Development Scale were increased in both groups. While the increases in MDI and PDI were greater in the brain injury group than in the non-brain injury group（ P〈0. 01）,the absolute values of these two indexes were comparable between groups after treatment（ P〈0. 05）. The proportions of newborns with post-treatment PDI and MDI≥85 were significantly higher in the brain injury group（ 90. 4% and 86. 5%,respectively） than those in the non-brain injury group（ P〈0. 05）. Conclusion： The serum bilirubin level is closely related to brain injury.A serum total bilirubin of 513μmol / L can be used as a threshold for subclinical bilirubin brain damage.Newborns with this threshold bilirubin level should be intervened early in order to avoid occurrence of subclinical bilirubin brain injury. Brain MRI can detect subclinical bilirubin brain damage and therefore allow for early treatment and better prognosis.