18-氟脱氧葡萄糖正电子发射断层/CT及振幅整合脑电图评价亚低温治疗新生儿胆红素脑病的疗效

Effect of Mild Hypothermia Therapy on Neonatal Bilirubin Encephalopathy: Evaluated with ^(18)F-fluorodeoxyglucose Positron Emission Tomography/CT and Amplitude Integrated Electroencephalogram

目的探讨亚低温治疗新生儿胆红素脑病的临床疗效及18-氟脱氧葡萄糖(^(18)F-FDG)正电子发射断层(PET)/CT和振幅整合脑电图(a EEG)的诊断和疗效判断价值。方法 2013年5月至2014年12月,29例胆红素脑病患儿分为常规组(n=15)和亚低温组(n=14)。常规组采用常规治疗,亚低温组加用选择性头部亚低温治疗。观察两组患儿治疗前后a EEG、神经烯醇化酶(NSE)及治疗后的^(18)F-FDG PET/CT脑葡萄糖代谢率。结果两组NSE治疗后均显著降低(t>9.670,P<0.001),亚低温组治疗后NSE显著低于常规组(F=46.146,P<0.001)。两组治疗后a EEG的睡眠觉醒周期(SWC)、癫痫样活动及异常程度均有改善(P<0.05),亚低温组治疗后的SWC、癫痫样活动及异常程度恢复更好(P<0.05)。亚低温组治疗后各脑区脑葡萄糖代谢改善明显优于常规组(Z>2.943,P<0.01)。脑葡萄糖代谢率与a EEG及NSE改变呈负相关(r>0.640,P<0.05)。结论亚低温治疗新生儿急性胆红素脑病,可更好地促进脑细胞能量代谢恢复;^(18)F-FDG PET/CT和a EEG可用于胆红素脑病的早期诊断及疗效判断,具有一定临床价值。

Objective To investigate the clinical effect of mild hypothermia on neonatal bilirubin encephalopathy, and the value of ~F-fluorodeoxyglucose （18^F-FDG） positron emission tomography （PET）/CT and amplitude integrated electroencephalogram （aEEG） for diagnosis and evaluation of curative effect. Methods From May, 2013 to December, 2014, 29 newborns with bilirubin encephalopathy were divided into conventional group （n=15） and mild hypothermia group （n=14）. The conventional group received conventional therapy, and the other group received mild hypothermia in addition. The aEEG and neuron-specific enolase （NSE） were measured before and after treatment, as well as the glucose metabolism rate with 18^F-FDG PET/CT after treatment. Results The NSE was lower after treatment in both groups （t〉 9.670, P〈0.001）, and was lower in the mild hypothermia group than in the conventional group （F=46.146, P〈0.001）. After treatment, sleep-wake cycle （SWC）, epileptiform activity and the degree of abnormality were obviously improved （P〈0.05）, and were better in the mild hypothermia group than in the conventional group （P〈0.05）. The cerebral glucose metabolism rate was significantly better in the mild hypothermia group than in the conventional group （t〉2.943, P〈0.01）. The cerebral glucose metabolism rate was negatively correlated with aEEG and NSE （r〉0.640, P〈0.05）. Conclusion Mild hypothermia therapy could further promote the energy metabolism of brain cells in neonatal bilirubin encephalopathy. 18^F-FDG PET/CT and aEEG can be used for early diagnosis and therapeutic evaluation.