新生儿缺氧缺血性脑病MRI和^1HMRS检查的临床意义  

The clinical significance of MRI and 1 HMRS in newborn infants with hypoxic ischemic encephalopathy

作　　者：曾超美[1,2] 李庆丰[1,2] 刘方 郭静竹[1,2] 蒲永林 关立夫 

机构地区：[1]北京医科大学附属人民医院儿科 [2]首都医科大学附属北京儿童医院放射科

出　　处：《中华儿科杂志》1999年第2期69-72,共4页Chinese Journal of Pediatrics

摘　　要：目的研究新生儿缺氧缺血性脑病（ＨＩＥ）时脑形态学及代谢改变，并探讨其与临床的关系。方法对２１例ＨＩＥ新生儿进行头颅ＭＲＩ和１ＨＭＲＳ检查，并以７例无窒息史的新生儿作为对照。结果ＭＲＩ显示ＨＩＥ患儿均存在不同程度的脑水肿，但脑水肿的范围轻度组与中、重度组无明显差异（Ｐ＞０．０５），而脑实质及基底节区出血发生率中、重度组高于轻度组（Ｐ＜０．０５）。１ＨＭＲＳ显示缺氧早期总肌酸／乳酸（Ｌａｃ／Ｃｒ）比值ＨＩＥ组高于对照组（Ｐ＜０．０５），谷氨酸复合物α（Ｇｌｘα）／Ｃｒ比值中、重度组明显高于轻度组（Ｐ＜０．０１），并且明确的Ｇｌｘα／Ｃｒ共振峰仅见于中、重度组ＨＩＥ患儿。恢复期Ｌａｃ／Ｃｒ及Ｇｌｘα／Ｃｒ比值明显下降。结论ＭＲＩ和ＭＲＳ技术相结合可无创性地动态监测ＨＩＥ患儿脑形态及代谢变化，对于新生儿ＨＩＥ的临床诊断、疗效监测及预后评估有重要临床意义。Objective To study the morphology and metabolic alterations in the brain of neonates with hypoxic ischemic encephalopathy (HIE) and correlate those alterations with clinical manifestation. Methods MRI and 1 HMRS were performed in 21 neonates with HIE. Seven infants without evidence of birth asphyxia were studied as controls. Results MRI showed that all neonates with HIE existed cerebral edema, but there was no significant difference in the areas of cerebral edema between mild group and moderate severe group ( P >0.05). The incidences of cerebral parenchymal hemorrhage and basal ganglia hemorrhage in moderate severe group were significantly higher than those in mild group ( P <0.05). 1 HMRS showed that in the early period of hypoxia Lac/Cr ratio was significantly higher in HIE group than that in control group ( P <0.05). Glx a/Cr ratio was significantly higher in moderate severe group than that in mild group ( P <0.01). An obvious peak from Glx a could only be detected in moderate severe group of HIE. In the convalescence of HIE Lac/Cr and Glx a/Cr ratios significantly decreased. Conclusion MRI and MRS are useful tools for monitoring the brain morphology and metabolic changes noninvasively. They have the great clinical significance for the diagnosis, monitoring the treatment and evaluation of prognosis of the newborn infants with HIE.

关 键 词：新生儿 缺氧缺血性脑病 NMR 成像 HMRS 

分 类 号：R722.120.4[医药卫生—儿科] R445.2[医药卫生—临床医学]