新生儿低血糖导致的脑损伤的风险因素及影像学特征分析

Risk Factors and Imaging Features of Brain Injury caused by Neonatal Hypoglycemia

目的 探讨新生儿低血糖导致的脑损伤的风险因素及影像学特征。方法 选取2020年8月至2021年7月我院收治的154例低血糖新生儿进行回顾性分析,均采用磁共振成像(MRI)评估脑损伤情况,并进行单因素分析与Logistic多因素回归分析。结果 154例低血糖新生儿中发生脑损伤27例(17.53%),与未发生组比较,发生组早产、围产期缺氧、喂养困难、惊厥、脑电图(EEG)异常、母亲合并妊娠糖尿病、低血糖持续时间>24h、脑红蛋白(NGB)水平≥150mg/L、神经元特异性烯醇化酶(NSE)水平≥50μg/L的患儿占比均更高(P<0.05);Logistic多因素分析结果 显示,胎龄(OR=1.902)、围产期缺氧(OR=1.781)、喂养困难(OR=2.395)、惊厥(OR=12.366)、EEG异常(OR=15.251)、母亲合并妊娠糖尿病(OR=8.793)、低血糖持续时间(OR=8.156)、NGB水平(OR=2.935)、NSE水平(OR=2.411)是影响低血糖脑损伤发生的独立危险因素(P<0.05);27例低血糖脑损伤患儿均存在顶枕部头皮层受累,磁共振扩散加权成像(DWI)均表现为高信号,14例(51.85%)患儿经T_1加权像(T1WI)、矢状面T2加权像(T2WI)均正常信号,2例(7.41%)T_1WI正常信号、T_2WI高信号,2例(7.41%)T_1WI低信号、T_2WI正常信号,9例(33.)33%T_1WI低信号、T_2WI高信号。结论 新生儿低血糖导致的脑损伤的风险因素包括胎龄、围产期缺氧、喂养困难、惊厥、EEG异常、母亲合并妊娠糖尿病、低血糖持续时间、NGB和NSE水平等,患儿影像学特征可表现为顶枕部头皮层受累、DWI高信号,部分患儿T_1WI、T_2WI信号异常。

Objective To explore the risk factors and imaging features of brain injury caused by neonatal hypoglycemia.Methods A total of 154 neonates with hypoglycemia from August 2020 to July 2021 who were admitted in our hospital were selected for retrospective analysis.Magnetic resonance imaging(MRI)was used to evaluate brain injury,and univariate analysis and logistic multivariate regression were performed.Results In 154 neonates with hypoglycemia,27(17.53%)occurred brain injury.Compared with the non-incidence group,the proportion of preterm birth,perinatal hypoxia,feeding difficulties,convulsions,abnormal electroencephalogram(EEG),mother complicated with gestational diabetes,hypoglycemia duration>24h,and NG B level≥150mg and neuron-specific enolase(NSE)levels≥50μg/L in the occurrence group were higher(P<0.05).Logistic multivariate analysis showed that gestational age(OR=1.902),perinatal hypoxia(OR=1.781),feeding difficulties(OR=2.395),convulsions(OR=12.366),abnormal EEG(OR=15.251),Maternal gestational diabetes mellitus(OR=8.793),duration of hypoglycemia(OR=8.156),NG B level(OR=2.935),and NSE level(OR=2.411)were independent risk factors for hypoglycemic brain injury(P<0.05).27 children with hypoglycemic brain injury all had parietooccipital scalp involvement,and all showed hyperintensity on diffusion-weighted magnetic resonance imaging(DWI),and 14 cases(51.85%)had normal signal on T1-weighted image(T1WI)and sagittal T2-weighted image(T2WI),2 cases(7.41%)had normal signal on T1WI and high signal on T2WI,and 2 cases(7.41%)had T1WI signal Low signal,normal signal on T2WI,9 cases(33.33%)with low signal on T1WI and high signal on T2WI.Conclusion:Risk factors for brain injury caused by neonatal hypoglycemia include gestational age,perinatal hypoxia,feeding difficulties,convulsions,abnormal EEG,maternal gestational diabetes mellitus,duration of hypoglycemia,NG B and NSE levels,etc.Histological features can be manifested as parietooccipital scalp involvement,high signal on DWI,and abnormal signal on T1WI and T2WI in some children.