磁共振波谱在早产儿神经系统发育落后早期预测的价值

Application values of ~1H-MRS in the early prediction for nervous system development delayed in preterm infants

目的探讨早产儿1H-MRS脑内代谢物与Gesell发育商间的相关性,为早产儿神经系统发育落后的早期诊断及预测提供帮助。方法对我院符合条件的45例早产儿及30例同期足月儿于出生后1周内行1H-MRS检查,计算脑内代谢物NAA/Cr、Cho/Cr、m I/Cr、Lac/Cr、Glx/Cr比值;并于出生后40~52周行Gesell发育诊断量表检测,得出发育商及其5个能区对应的发育商值,同时分析早产儿组发育商与脑内各代谢物间的相关性。结果早产儿组NAA/Cr显著低于足月儿组,差异有统计学意义（t=-6.202,P〈0.001）,但Cho/Cr、Lac/Cr、Glx/Cr均显著高于足月儿组,差异有统计学意义（P〈0.001）。早产儿组发育商及其各能区均显著低于足月儿组,差异有统计学意义（P〈0.001）。多元线性回归模型显示发育商与NAA/Cr及Lac/Cr存在显著相关性（决定系数为0.418）。结论早产儿早期1H-MRS脑内代谢物质（NAA、Lac）与Gesell发育商有相关性,NAA、Lac的变化可以早期预测早产儿可能发生的神经系统发育落后。

Objective To explore the correlations between the brain metabolites and the development quotient in the preterm infants,thus to provide a important informations for the early diagnosis and prediction of nervous system development delayed in the preterm infants. Methods Total of 45 cases with preterm and 30 cases with full-term underwent1H-MRS scan within 1 week of birth to collect their brain metabolite data,including the NAA / Cr,Cho / Cr,Lac / Cr,Glx / Cr and MI / Crr. The Gesell examination was performed at postnatal 40 ~ 52 weeks. The values of the development quotient and its five functional areas were recorded.The correlations between the brain metabolites and the development quotient were analyzed by Multiple linear regression analysis.Results The value of NAA / Cr in the premature infant was lower than that of the full term infant,the difference was statistically significant（ t =-6. 202,P〈0. 001）. The values of Cho / Cr,Lac / Cr and Glx / Cr were higher than that of the full term infant,the difference was statistically significant（ P〈0. 001）. The multiple linear regression analysis demonstrated that the development quotient had significant correlations with the values of NAA / Cr and Lac / Cr（ determination coefficient was 0. 418）. Conclusion There was significant correlation between the brain metabolites（ NAA and Lac） in the early1H-MRS and the Gesell developmental quotient in the preterm infants suggests that the NAA and Lac may be an early predictive indicator in the nervous system development delayed in the preterm infants.