高促甲状腺素血症早产儿脑损伤诊断方法的临床应用

Clinical application of diagnostic methods for brain damage in premature infants with hyperthyroidism

目的 :探讨振幅整合脑电图(amplitude-integrated electroencephalography,a EEG)、血清S100B蛋白、头颅磁共振成像(magnetic resonance imaging,MRI)、神经行为量表在高促甲状腺素血症(hyperthyrotropinemia,HT)早产儿脑损伤中的诊断价值。方法:将南通大学附属医院新生儿重症监护病房2013年12月—2015年6月间确诊为HT的78例早产儿纳入为研究对象,出生后6 h内监测a EEG,24 h检测血清S100B,7~10 d检查头颅MRI,纠正胎龄满40周后7、14、28 d评估新生儿神经行为测定(neonatal behavioral neurological assessment,NBNA)评分,纠正胎龄3、6、12个月时检测婴幼儿智能发育量表(Children′s Developmental Center of China,CDCC),计算各指标诊断脑损伤的灵敏度、特异度,采用Kappa检验比较各指标与脑损伤的吻合度。结果:(1)a EEG的灵敏度、特异度及K值均较高,分别为91.30%、94.50%、84.80%。(2)a EEG在生后6 h内即能有助于诊断脑损伤。结论 :a EEG、血清S100B、头颅MRI、NBNA、CDCC均可用于诊断HT早产儿脑损伤,a EEG可作为超早期(6 h内)有效的辅助诊断指标。

Objective： To discuss the diagnostic value of amplitude-integrated electroencephalography（a EEG）, serum S100 B protein, magnetic resonance imaging（MRI）, and nerve behavior scale in the brain injury of preterm infants with hyperthyrotropinaemia（HT）. Methods： The clinical data of 78 cases of premature infants diagnosed with HT from December 2013 to June 2015 were enrolled in the study, 6 hours a EEG and 24 h serum S100 B protein after birth. Head MRI examination at 7-10 days, neonatal behavioral neurological assessment（NBNA） respectively at the 7, 14 and 28 days after corrected gestational age over 40 weeks and correcting gestational age 3, 6, and 12 months for Children′s Developmental Center of China（CDCC）.Calculating sensitivity and specificity of each indicator in diagnosing brain injury, Comparing the indexes of each index and the degree of brain injury by Kappa test. Results：（1）The sensitivity, specificity and K values of a EEG were higher, 94.50%,91.30% and 84.80% respectively.（2）a EEG can help diagnose brain damage within 6 hours after birth. Conclusion： AEEG,serum S100 B, head MRI, NBNA and CDCC can be used for the diagnosis of brain damage in premature infants with hyperthyroidism, and a EEG can be used as an auxiliary diagnostic marker for super early（6 hours）.