大脑中动脉血流动力学参数在新生儿缺血缺氧性脑病诊断和预后预测中的价值

Values of hemodynamic parameters of middle cerebral artery in diagnosis and prognosis prediction of neonatal HIE

目的:分析大脑中动脉(MCA)血流动力学参数在新生儿缺血缺氧性脑病(HIE)诊断和预后预测中的价值。方法:选取43例HIE新生儿作为研究组,择同期43名健康新生儿作为对照组,回顾性分析两组新生儿的经颅多普勒超声(TCD)测定MCA的血流动力学指标和研究组患儿的预后情况。采用受试者工作特征(ROC)曲线分析收缩期峰值流速(Vs)、舒张末期流速(Vd)、阻力指数(RI)等血流动力学参数诊断HIE和预测患儿预后的价值。结果:研究组患儿的羊水污染比例高于对照组,出生后1 min Apgar评分分布低于对照组,差异均有统计学意义(P<0.05)。研究组患儿MCA的Vd水平高于对照组,RI水平低于对照组,差异均有统计学意义(P<0.05)。Vd和RI诊断HIE的ROC曲线下面积(AUC)分别为0.64和0.674(P<0.05),在Cut-off值下,灵敏度分别为0.442和0.930,特异度分别为0.814和0.419。研究组中有10例患儿预后不良,占23.26%。预后不良组患儿的Vs水平、Vd水平均高于预后良好组,RI水平低于预后良好组,差异均有统计学意义(P<0.05)。Vs、Vd和RI预测HIE预后的AUC分别为0.759、0.829、0.809(P<0.05),在Cut-off值下,灵敏度分别为0.500、0.700、0.879,特异度分别为0.939、1.000、0.700。结论:HIE患儿表现为MCA血流动力学参数异常,预后不良患儿相关指标的变化更加显著,MCA血流动力学参数可用于辅助HIE的诊断和预后预测。

Objective:To analyze the values of hemodynamic parameters of middle cerebral artery(MCA)in the diagnosis and prognosis prediction of neonatal hypoxic-ischemic encephalopathy(HIE).Methods:43 neonates with HIE were collected as the study group,and 43 healthy newborns in the same period were selected as the control group.The hemodynamic parameters of MCA measured by transcranial Doppler(TCD)of newborns between the two groups and the prognosis of the children in the study group were analyzed retrospectively.The receiver operating characteristic(ROC)curve was used to analyze the values of hemodynamic parameters such assystolic peak velocity(Vs),end diastolic velocity(Vd),and resistance index(RI)in diagnosing HIE and predicting the prognosis of children.Results:The proportion of amniotic fluid pollution of the children in the study group was higher than that in the control group,and the distribution of Apgar score 1 minute after birth was lower than that in the control group.The differences between the two groups was statistically significant(P<0.05).The Vd level of MCA of the children in the study group was higher than that in the control group,and the RI level was lower than that in the control group.The differences between the two groups was statistically significant(P<0.05).The area under ROC curve(AUC)of Vd and RI in the diagnosis of HIE were 0.64 and 0.674(P<0.05),respectively.Under the Cut-off value,the sensitivities were 0.442 and 0.930,and the specificities were 0.814 and 0.419,respectively.In the study group,10 children had poor prognosis,accounting for 23.26%.The levels of Vs and Vd in the poor prognosis group were higher than those in the good prognosis group,and the level of RI was lower than that in the good prognosis group.The difference between the two groups was statistically significant(P<0.05).The AUC of Vs,Vd and RI in predicting the prognosis of HIE were 0.759,0.829 and 0.809,respectively(P<0.05).Under the Cut-off value,the sensitivities were 0.500,0.700 and 0.879,respectively,and the specificities were 0.939,1.000 and 0.700,respectively.Conclusion:Children with HIE show abnormal hemodynamic parameters of MCA,and the changes of these indexes are more significant in children with poor prognosis.MCA hemodynamic parameters can be used to assist in the diagnosis and prognosis prediction of HIE.