超声灰度值测定诊断围产期脑白质损伤的作用  

Diagnostic value of ultrasound gray scale measurement in perinatal white matter injury

作　　者：樊曦涌[1] 周丛乐[1] 王红梅[1] 汤秀英[2] 汤泽中[1] 侯新琳[1] 姜毅[1] 张欣[1] 李星[1] 

机构地区：[1]北京大学第一医院儿科,100034 [2]北京大学第一医院电镜室,100034

出　　处：《中华围产医学杂志》2011年第9期523-529,共7页Chinese Journal of Perinatal Medicine

摘　　要：目的探讨超声灰度值测定在围产期脑白质损伤早期定量评价中的价值。方法对生后7d内超声诊断为脑白质病变的新生儿104例及对照组48例新生儿在生后早期进行常规颅脑超声检查，在超声影像定性判断基础上，应用医学图像分析软件测定侧脑室后角三角区脑白质的超声灰度值。病例组新生儿生后1个月内复查颅脑超声，记录白质回声强弱及有无囊腔；出院后3～6月龄时再次复查颅脑超声，记录白质容积改变、侧脑室的形态及囊腔变化；1．5～2岁时采用Gesell评分定量评价神经功能，分为正常和异常2类。采用受试者工作特性曲线分析新生儿期脑白质灰度值与后期神经系统发育的关系。结果新生儿期重度损伤组脑白质平均灰度值为131．72±2．40，高于轻度损伤组（116．61±2．48），轻度损伤组高于对照组（100．50土1．66），差异均有统计学意义（q分别=4．521和4．492，P均〈0．05）。受试者工作特性曲线分析显示，新生儿期脑白质灰度值〉114．37有助于诊断白质损伤，其敏感性0．721，特异性0．854；灰度值〉119．80有助于诊断重度脑白质损伤，其敏感性0．716，特异性0．776。随灰度值的增加，损伤后期出现脑白质容积减少及侧脑室扩大的比例增加，其中灰度值〉130者更易发生白质软化。新生儿期脑白质灰度值〈110的患儿在2岁前遗留神经系统发育异常的比例为5．0％，在灰度值110～120的患儿中比例为27．8％，在灰度值〉120的患儿为47．8％。结论超声定量分析脑白质灰度值在围产期脑白质损伤的早期诊断中具有重要的实用意义，有助于早期判断白质损伤的结局和远期神经发育预后。Objective To investigate the value of early quantified analysis of perinatal white matter injury by cranial ultrasound gray scale measurement. Methods The cranial ultrasound exam was performed in 152 newborns with different gestational ages early after their birth. These newborns were divided into two groups： 104 newborns diagnosed as white matter injury within 7 days after birth were taken as patient group; while 48 newborns who were not were taken as control group. The gray scale values in the trigone of lateral ventricle of white matter were analyzed by medical image analysis system. The newborns in patient group accepted cranial ultrasound exam at one month after birth, the grey scale value and cyst in the white matter were recorded. Three to six months old, the cranial ultrasound exam was repeated to record the change of white matter volume, morphology of lateral ventricle and change of the cysts. When they were 1.5 to 2 years old, the neurological function were quantitatively evaluated with Gesell score, and the results were Classified as normal and abnormal. The relationships between gray scale value and neuro-developmental outcome were analyzed with receiver operating characteristic curve. Results During neonatal period, the average gray scale values in severely injured group was 131.72±2.40, higher than that of mildly injured group （116.61±2.48）, and which in mildly injury group was higher than that in control group （100.50±1.66）（q=4. 521 and 4. 492, P〈0.05）. It was showed by receiver operating characteristic curve that gray scale value 〉114.37 could help to diagnose white matter injury, with the sensitivity of 0. 721 and the specificity of 0. 854; gray scale value 〉119.80 could help to diagnose severe white matter injury,with the sensitivity of 0. 716 and the specificity of 0. 776. As the gray scale value increased, the incidence of white matter volume decreased and the enlargement of lateral ventricle in the later period of injury increased. Patients with gray scale value 〉130

关 键 词：白质软化病 脑室周围 侧脑室 超声检查 小神经胶质细胞 婴儿 新生 

分 类 号：R714.7[医药卫生—妇产科学]