氢质子磁共振波谱在婴幼儿重症肠道病毒71脑炎的应用  

Application of proton magnetic resonance spectroscopy in infants and young children with severe enterovirus 71 encephalitis

作　　者：郭予雄[1] 何少茹[1] 翟琼香[1] 黄飚[2] 钟敏泉[1] 林晓源[1] 桂娟[3] 

机构地区：[1]广东省人民医院广东省医学科学院广东省神经科学研究所,广州510080 [2]广东省人民医院广东省医学科学院广东省神经科学研究所放射科,广州510080 [3]广东省人民医院广东省医学科学院广东省神经科学研究所PICU,广州510080

出　　处：《广东医学》2011年第15期1967-1970,共4页Guangdong Medical Journal

基　　金：广东省医学科研基金资助项目(编号:C2010020)

摘　　要：目的探讨氢质子磁共振波谱(1H-MRS)在婴幼儿重症肠道病毒71(EV71)脑炎中的早期表现及应用价值。方法对25例婴幼儿重症EV71脑炎(病例组)进行分期,于起病5 d内行脑干1H-MRS检查,主要检测指标为N-乙酰天门冬氨酸(NAA)、肌酸(Cr)、胆碱(Cho)及峰下面积比值NAA/Cr、Cho/Cr和NAA/Cho+Cr,并与10名健康儿童(对照组)进行比较。结果病例组与对照组年龄的差异无统计学意义(t=0.048,P=0.962),对照组1H-MRS和MRI均未见异常。病例组Ⅱ期16例,Ⅲa期5例,Ⅲb期4例。Ⅱ期及Ⅲ期与对照组相比:Ⅱ期Cho/Cr差异无统计学意义(P>0.05),Ⅲ期Cho/Cr显著增高(P<0.05)。Ⅲa期与Ⅱ期比较:Cho/Cr增高,NAA/Cho+Cr降低(均P<0.01),Ⅲb期与Ⅱ期比较:NAA/Cr、NAA/Cho+Cr降低,Cho/Cr增高(均P<0.01)。Ⅲa期与Ⅲb期相比:Ⅲb期NAA/Cr、NAA/Cho+Cr降低(分别P<0.01和P<0.05),Cho/Cr差异无统计学意义(P>0.05)。结论重症EV71脑炎早期1H-MRS表现为NAA/Cr、NAA/Cho+Cr下降,Ⅲ期伴Cho/Cr增高,提示早期神经元损害、神经元丢失或功能障碍,可伴有髓鞘破坏或胶质细胞增生;1H-MRS生化代谢改变越明显,临床症状越重,预后越差;1H-MRS有助弥补MRI不足,能敏感检测重症EV71脑炎早期脑代谢物质变化。Objective To investigate the early manifestation and clinical application of proton magnetic resonance spectroscopy （^1H - MRS） in infants and young children with severe enterovirus 71 （EV71） encephalitis. Methods ^1H - MRS scan was carried out in 25 children with different stages of severe EV71 encephalitis 5 days after onset of the disease. The concentrations of Nacetyl- as -partate （NAA） , Creatine （Cr） and choline contained compounds （Cho） , and the NAA/Cr, Cho/Cr and NAA/（ Cho ＋ Cr） ratios of stembrain were assessed. Comparison was performed with 10 normal healthy subjects as controls. Results There was no significant difference in age between encephalitis and control groups （t = 0. 048, P =0. 962）. No abnormality was observed on either 1H -MRS or MRI in control group. There were 16, 5 and 4 cases classified into clinical stage Ⅱ , Ⅲ a and Ⅲ b, respectively. There was significant increase of Cho/Cr ratio in patients at stage Ⅲ, when comparing with that of controls （ P 〈 0.05 ）, while no significant difference was revealed in those at stage Ⅱ. There were significant increase of Cho/Cr ratio and reduction of NAA/（ Cho ＋ Cr） ratio revealed in patients at stage Ⅲa, when comparing with those at stage Ⅱ （both P 〈0. 01 ）. Moreover, significant reduction of NAA/Cr and NAA/（ Cho ＋ Cr） ratios and elevation of Cho/Cr ratio were revealed in patients at stage Ⅲ b, when comparing with those at stage Ⅲ （ All P 〈 0. 01 ）. Meanwhile, significant reduction of NAA/Cr and NAA/（ Cho ＋ Cr） ratios were revealed in patients at stage Ⅲb, comparing with those at stage Ilia （P 〈0. 01, and P 〈0. 05, respectively） , with no significant difference in Cho/Cr ratio revealed （ P 〉 0. 05 ）. Conclusion Conclusion Reduction of NAA/Cr and NAA/（ Cho ＋ Cr） are presented on 1H - MRS in early severe EV71 encephalitis. The increase of Cho/Cr in stage 11I suggests the neuron injury, apoptosis or dysfunction, complicating with demyelination and gl

关 键 词：肠道病毒71 脑炎 氢质子磁共振波谱 儿童 

分 类 号：R742.1[医药卫生—神经病学与精神病学]