超声灰度比值分析对新生儿高胆红素血症颅内基底神经核监测价值初探

Value of ultrasound gray ratio analysis in monitoring intracranial basal ganglia of neonates with hyperbilirubinemia

目的探讨颅脑超声(CUS)苍白球与壳核灰度比值对新生儿高胆红素血症的颅内基底神经核监测价值。方法回顾性分析2022年6月至2023年6月在首都儿科研究所附属儿童医院新生儿内科住院的69例患儿的CUS、临床及磁共振成像(MRI,46例)资料。使用UpToDate calculator计算每例患儿的光疗参考阈值,并结合342μmol/L节点值,将患儿分为对照组、轻-中度高胆红素血症组和重度高胆红素血症组;使用RadiAnt DICOM Viewer软件读取双侧苍白球与壳核超声灰度值,并计算比值CUS(G/P);使用MRI后处理工作站读取双侧苍白球和壳核T1信号值,并计算比值MRI(G/P)。分析CUS(G/P)与血清总胆红素(TSB)/光疗阈值、TSB/白蛋白值的相关性;CUS(G/P)与MRI(G/P)进行一致性分析;比较对照组、轻-中度高胆红素血症组、重度高胆红素血症组三组间CUS(G/P)差异。结果①CUS(G/P)与TSB/光疗阈值、TSB/白蛋白值呈正相关(rs=0.721、0.600,均P<0.001)。②CUS(G/P)值与MRI(G/P)值存在一致性(τ=0.743,P<0.05)。③CUS(G/P)值在对照组、轻-中度高胆红素血症组、重度高胆红素血症组依次增高,两两组间差异有统计学意义(均P<0.05)。结论CUS(G/P)值和TSB间存在剂量反应关系,与MRI(G/P)值具有诊断一致性,在不同程度胆红素水平组间存在差异,可用于新生儿高胆红素血症的颅内基底神经核监测。

Objective To investigate the value of cranial ultrasound(CUS)globus pallidus to putamen gray ratio(G/P)in monitoring basal ganglia of neonatal hyperbilirubinemia.Methods A retrospective analysis was performed on the CUS,magnetic resonance imaging(MRI,46 cases)and clinical data of 69 neonates hospitalized in the Department of Neonatology of Children′s Hospital Affiliated to Capital Institute of Pediatrics from June 2022 to June 2023.UpToDate calculator was used to calculate the reference thresholds of phototherapy for each child,combined with the 342μmol/L node value,the children were divided into control group,mild to moderate hyperbilirubinemia group and severe hyperbilirubinemia group;RadiAnt DICOM Viewer software was used to measure the ultrasound gray values of bilateral globus pallidus and putamen,and the ratio CUS(G/P)was calculated;MRI post-processing workstation was used to read T1 signal values of bilateral globus pallidus and putamen,and the ratio MRI(G/P)was calculated.The correlations between CUS(G/P)and total serum bilirubin(TSB)/phototherapy threshold and TSB/albumin ratio were analyzed;the consistency of CUS(G/P)and MRI(G/P)was analyzed;the difference of CUS(G/P)among control group,light-moderate hyperbilirubinemia group and severe hyperbilirubinemia group was compared.Results①CUS(G/P)was positively correlated with TSB/phototherapy threshold and TSB/albumin(rs=0.721,0.600,all P<0.001).②CUS(G/P)value was consistent with MRI(G/P)value(τ=0.743,P<0.05).③CUS(G/P)value increased sequentially in the control group,mild-moderate hyperbilirubinemia group,and severe hyperbilirubinemia group,and the differences between each two groups were statistically significant(all P<0.05).Conclusions CUS(G/P)has dose-response relationship with TSB,diagnostic agreement with MRI(G/P)value,and shows differences in different levels of bilirubin,and can be used to monitor intracranial basal ganglia in neonatal hyperbilirubinemia.