MRI结合Gesell测试对足月新生儿HIE预后判断的研究

Study on the evaluation value of MRI combined with Gesell Developmental Schedules for the prognosis of hypoxic-ischemic encephalopathy in term infants

目的探讨头颅磁共振成像(MRI)结合格赛尔(Gesell)发育诊断量表测试对足月新生儿缺氧缺血性脑病(HIE)患儿预后的判断价值。方法收集2008年3月至2011年3月于西安交通大学第一附属医院新生儿科住院的104例足月新生HIE患儿为研究对象,分别于新生儿期、4月龄时行头颅MRI检查,于4个月、1岁行Gesell发育诊断量表测试。分析MRI检查结果,比较其与Gesell发育诊断量表测试结果之间的相关关系,探讨二者对HIE患儿预后的判断价值。结果 HIE患儿MRI表现颅内出血发生率最高96.2%(100/104),蛛网膜下腔或硬膜下出血(SAH/SDH)为主占80.0%(80/100),其次脑水肿占88.5%(92/104)。初次M RI正常或轻度异常者,复查M RI正常或仅有外部性脑积水表现;初次M RI中-重度异常者,复查M RI可能有脑萎缩、脑软化、多囊薄改变伴或不伴有基底节大理石样改变、髓鞘发育延迟、较多外部性脑积水表现。早期MRI预测足月HIE预后的灵敏度为100.0%(13/13),特异度为69.6%(16/23)。HIE患儿在Gesell发育诊断量表5项测试结果中,精细运动、语言发育商(DQ)均低于适应性、大运动及个人-社交发育商,其中以精细运动障碍最为显著。采用Spearman等级相关性分析法显示新生儿期MRI分度与4个月适应性DQ之间呈负相关(rs=-0.754,P<0.001)。结论 MRI从客观角度出发,显示头颅解剖结构,其损伤严重程度可预示临床预后,Gesell发育诊断量表测试是从临床角度出发评估预后,将二者结合起来判断新生儿HIE预后具有较大的临床应用价值。

Objective To explore the evaluation value of MRI combined with Gesell Developmental Schedules for the prognosis of hypoxic- ischemic eneephalopathy （HIE） in term infants. Methods A total of 104 term infants with HIE were selected as research objects. All those infants were hospitalized at department of pediatrics in the First Affiliated Hospital of Xi＇ an Jiaotong University from March 2008 to March 2011. They underwent head MRI scans during neonatal period and at the age of four months, respectively. Besides, they received Gesell Developmental Schedules at the age of four months and one year old, respectively. Results of MRI scans were analyzed to explore its correlations with the results of Gesell Developmental Schedules so as to investigate the evaluation value of them for the prognosis of term infants with HIE. Results Head MRI scans of HIE patients showed the highest incidence rate of intracranial hemorrhage, which reached 96.2% （100/104）. Besides, subarachnoid hemorrhage or subdural hemorrhage （SAH/SDH） was detected in 80.0% （80/100） of the patients. In addition, eneephaledema was identified in 88.5% （92/104） of the patients. As for patients whose preliminary MRI results were normal or with slight abnormality, their MRI reexamination results turned to be normal or only showed external hydrocephalus. As for patients whose preliminary MRI results showed moderate to severe abnormalities, their MRI reexamination results may indicate encephalatrophy, encephalomalacia, polyeystic change complicated with or without status marmoratus of basal ganglia, delayed myelination and external hydrocephalus. The sensitivity of early MRI for the prediction of the prognosis of HIE in term infants reached 100.0% （ 13/ 13）, while its specificity amounted to 69.6% （16/23）. As to the results of Gesell Developmental Schedules, HIE patients had lower scores of fine motor movements and development quotient （DQ） of language than those of the adaptability, gross motor movements, and individual-social interaction. Especially, patients had the lowest scores of fine motor movements. Spearman＇ s rank correlation analysis showed that there was a negative correlation between MRI grading during neonatal period and DQ of adaptability at the age of four months （ rs = - 0. 754, P 〈 0. 001 ）. Conclusion MRI displays the anatomical structure of skull objectively. Severity of the damage can indicate clinical prognosis. Gesell Developmental Schedules evaluate prognosis from the perspective of clinical manifestations. The combination of MRI and Gesell Developmental Schedules is of relatively great evaluation value to the prognosis of HIE in term infants.