低温治疗对轻度缺氧缺血性脑病新生儿脑部MR生物标志物和神经发育的影响研究

Effect of Hypothermia Treatment on MR Markers in the Brain of Neonatal Children with Encephalopathy

目的探讨低温治疗对轻度缺氧缺血性脑病(HIE)新生儿MR生物标志物和神经发育结果的影响。方法本实验收集2015年1月-2016年9月期间在达州市中西医结合医院儿科就诊的轻度缺氧缺血性脑病新生儿患者140例,随机分为两组,观察组(n=70)采用低温疗法,对照组(n=70)进行常规护理。出生后2周内进行磁共振和磁共振波谱(MRS)检查,2年后进行神经发育结果评估。结果两组婴儿的一般情况无明显差异(P>0.05)。观察组患儿的Apgar评分、住院时间和出生后6 h时的异常脑电图病例数显著高于对照组(P<0.05)。对照组患儿出生后6 d的癫痫病例数显著高于观察组(P<0.05)。观察组与对照组的基底神经节和丘脑、内囊后肢的MRI检查无明显差异(P>0.05)。观察组患儿白质异常比例、皮质损伤比例显著低于对照组(P<0.05)。两组Lac/NAA无明显差异(P>0.05),而观察组NAA/Cr和NAA/Cho的丘脑比率明显高于对照组(P<0.05)。2年后,观察组的MDI和PDI的Bayley评分均显著高于对照组(P<0.05)。结论 72 h的低温治疗对于轻度缺氧缺血性脑病新生儿的颅脑损伤有一定疗效,可降低脑白质和代谢性损伤发生率,提高婴幼儿神经发育评分,故低温治疗有一定神经保护作用。

Objective To investigate the effect of hypothermia treatment on MR biomarkers and neurodevelopmental outcomes in children with mild hypoxic-ischemic encephalopathy(HIE).Methods A total of 140 patients with HIE were collected from hospital of integrated traditional Chinese and western medicine Jan.2015 to Sep.2016,and divided into two groups according to whether treated with hypothermia treatment,group A(n=70)for hypothermia treatment,group B(n=70)for conventional treatment.We obtained MRS in 2 weeks after birth,and evaluated neurodevelopmental results when 2 years later.Results The Baseline characteristics in the observation group and the control group were no significant difference(P>0.05).The Apgar score,hospitalization time and the number of abnormal EEG in the observation group were significantly higher than those in the control group(P<0.05).The epilepsy infants at 6 days after birth in the control group are statistically more than the observation group(P<0.05).There was no significant difference between the observation group and the control group in the MRI examination of basal ganglia,thalamus and posterior limb of internal capsule(P>0.05).The proportion of abnormal white matter and cortex injury in the observation group was significantly lower than that in the control group(P<0.05).Lac/NAA showed no significant statistical difference between the two groups(P>0.05),while the thalamus ratios of NAA/Cr and NAA/Cho in the observation group were significantly higher than those in the control group(P<0.05).After two years,the Bayley scores of MDI and PDI in the observation group were statistically higher than those in the control group.Conclusion The 72-hour hypothermia treatment has a certain effect on the craniocerebral injury of neonates with hypoxic ischemic encephalopathy,reduces the incidence of white matter and metabolic injury,and improves the neurodevelopmental score of infants,indicating that hypothermia treatment has a certain neuroprotective effect.