苍白球与壳核T1WI信号强度比值在新生儿急性胆红素脑病分级及预后中的价值

The value of T1WI signal intensity ratio of globus pallidus to putamen in grading and predicting prognosis of neonatal acute bilirubin encephalopathy

目的 探讨新生儿急性胆红素脑病（ABE）苍白球与壳核T1WI信号强度比值（G/P比值）与ABE分级及预后的关系.方法 2013年1月至2015年12月收集85例足月新生儿ABE患儿,依据胆红素致神经功能障碍（BIND）进行评分,分为轻、中、重度组各56、19、10例,分别进行头颅MRI检查;64例患儿半年后随访复查,根据Gesell发育量表评估分为预后良好组44例、预后不良组20例,其中23例复查头颅MRI.测量首次MRI检查的双侧苍白球与壳核T1WI信号强度并计算其G/P比值,记录检查时日龄.轻、中、重度3组ABE患儿的G/P比值结果以及日龄的比较采用单因素方差分析,预后良好组、预后不良组采用独立样本t检验进行比较分析.通过ROC曲线分析G/P比值预测预后状况.结果 轻、中、重度组ABE患儿G/P比值分别为1.12±0.05、1.30±0.09、1.38±0.05,差异有统计学意义（F=38.90,P〈0.01）,3组间日龄差异没有统计学意义;预后不良组与预后良好组G/P比值分别为1.35±0.08、1.23±0.05,差异有统计学意义（t=-7.48,P〈0.01）,日龄差异无统计学意义.预后不良组G/P比值的ROC曲线下面积为0.896,最佳临界点为1.29,敏感度为85.0%,特异度为90.9%.结论 G/P比值可帮助临床对新生儿ABE进行分级;G/P比值可以帮助判断预后,当G/P比值〉1.29时提示患儿预后不良.

Objective To discuss the T1WI signal intensity ratio of globus pallidus to putamen in neonatal acute bilirubin encephalopathy（ABE）, and its relations with grading and prognosis evaluation in ABE. Methods Eighty-five cases of neonatal acute bilirubin encephalopathy from January 2013 to December 2015 were divided into three groups, including 56 cases of mild group, 19 cases of medium group, 10 cases of severe group depending on the scores of bilirubin induced neurological dysfunction （BIND） and correlated with cranial MRI examination. Sixty-four cases with follow-up for half a year, were divided into good prognosis group （44 cases） and poor prognosis group （20 cases） by Gesell development scales, and 23 patients had cranial MRI examination. Measurements of T1WI signal intensity of globus pallidus and putamen were made, the G/P ratio was calculated, and the day age of children was recorded . The G/P ratio and the day age of light, medium, severe groups using single factor analysis of variance between each other. Good prognosis group, poor prognosis group using homogeneity test of variances and then using independent sample to test for comparative analysis. Analysis of the line of ROC curve of G/P ratio was performed to predict prognosis. Results The G/P ratio of light, medium, severe groups are 1.12±0.05, 1.30±0.09, 1.38± 0.05, the difference had statistical significance（F=38.90,P〈0.01）.There was no statistical difference in the three groups of day age. The G/P ratio of good prognosis group and poor prognosis group were 1.35 ± 0.08, 1.23 ± 0.05 respectively,the difference had statistical significance（t=-7.48,P〈0.01）, The day age of these groups had no statistical difference. Analysis the ROC curve of G/P ratio, area under curve was 0.896, the best threshold was 1.29 and the sensitivity was 85.0%and the specific degreeswas 90.9%. Conclusion The G/P ratio could help clinical evaluation of neonatal ABE for grading. G/P ratio could predict prognosis, a G/P ratio of greater than 1.29 indicated poor prognosis.