不同胎龄和缺氧缺血性脑病新生儿脑^(18)F-FDG PET显像的临床研究  

Clinical significance of positron emission tomography in preterm,term newborn infants and neonatal hypoxic-ischemic encephalopathy

作　　者：史源[1,2] 赵锦宁[1] 金榕兵[3] 唐仕芳[1] 刘蕾[1] 李廷玉[2] 

机构地区：[1]第三军医大学附属大坪医院儿科,重庆400042 [2]重庆医科大学附属儿童医院儿童保健中心 [3]第三军医大学附属大坪医院核医学科,重庆400042

出　　处：《中华临床医师杂志（电子版）》2012年第1期59-65,共7页Chinese Journal of Clinicians(Electronic Edition)

基　　金：国家自然科学基金重点项目(30830106);儿童发育疾病研究省部共建重点实验室开放课题(EYKF200901)

摘　　要：目的对不同胎龄新生儿及新生儿缺氧缺血性脑病(HIE)患儿应用18F-FDGPET测定脑葡萄糖代谢,探讨PET测定脑葡萄糖代谢在不同胎龄新生儿中的变化及HIE中的临床应用价值。方法研究对象包括不同胎龄新生儿及HIE患儿,共计67例,其中7例因各种原因导致PET数据采集失败未纳入统计,其余60例新生儿纳入统计。其中,不同胎龄新生儿36例,包括≤32周4例,33～34周5例,35～36周12例,≥37周15例;HIE患儿24例,包括轻度13例,中度7例,重度4例。以RDSⅢ型回旋加速器获得18F后,通过自动化学合成装置制备18F-FDG溶液,在注射0.1mCi/kg18F-FDG后应用PET成像仪采集数据,并通过测定新生儿脑不同部位的标准摄取值(standardized uptake values,SUV)进行脑葡萄糖代谢半定量分析。结果比较不同胎龄新生儿18F-FDGPET脑显像,可见随着胎龄的成熟,新生儿脑葡萄糖活性呈现逐步增高的趋势,结构也变得较为清晰,尤其以胎龄达到足月新生儿标准(≥37周)后更为显著。不同胎龄新生儿脑18F-FDGPET显像的结果显示:其葡萄糖代谢活性在大脑皮层普遍较低,在丘脑则较高,其次为小脑、感觉运动皮质、基底节。胎龄≥37周的足月新生儿,其不同部位的葡萄糖代谢活性较胎龄<32周的早产儿显著增高(P<0.01)。与胎龄≥37周的足月新生儿相比,HIE患儿18F-FDGPET脑显像在所有测定的脑组织均呈现低代谢状况(P<0.05),而且,病情越重越为明显,重度HIE患儿脑葡萄糖代谢较轻、中度HIE患儿显著降低(P<0.05)。结论随着胎龄的成熟,新生儿脑葡萄糖活性呈现逐步增高的趋势,结构也变得较为清晰,尤其以胎龄达到足月新生儿标准(≥37周)后更为显著。HIE患儿PET脑显像存在明显18F-FDG代谢异常,且与病情严重程度相关。应用18F-FDGPET测定脑葡萄糖代谢为研究新生儿脑发育和损伤提供了新的方法,其临床意义值得进一步研究。Objective To study the clinical value of cerebral glucose metabolism measure by 18F-fluorodeoxyglucose（18F-FDG）PET in preterm,term newborn infants and neonatal hypoxic-ischemic encephalopathy（HIE）.Methods To measure the cerebral glucose metabolism by 18F-FDG PET imaging in 67 newborn infants.Seven neonates were excluded due to failure of data collection by PET,which caused by inadequate of administration of 18F-FDG,low dose of 18F-FDG,and crying or movement of the infants during PET course.Sixty infants were included in the study.Among them,36 preterm and term infants without any sign of brain injury were divided into 4 groups,including≤32 weeks（n=4）,33-34 weeks（n=5）,35-36 weeks（n=12）,and≥37 weeks group（n=15）,and the other 24 newborn infants suffering from HIE were divided into 3 groups,including mild HIE（n=13）,medium HIE（n=7）,and severe HIE group（n=4）.18F was obtained by RDSⅢCyclotron,and then,18F-FDG was produced by Chemistry Process Control Unit.The data was collected by PET instrument after administration of 0.1 mCi/kg 18F-FDG in the newborns,and standardized uptake values（SUV） were calculated to estimate the cerebral glucose metabolism.Results The cerebral glucose metabolism was found to have a trend to be increased,and the structure of brain 18F-FDG PET imaging to be clear with the increase of gestational age,especially when the gestational age was older than 37 weeks.The brain 18F-FDG PET imaging in different gestational age showed that the uptake of 18F-FDG was relatively higher in thalamus,cerebellum,sensorimotor cortex and basal ganglia,where as relatively lower in cerebral cortex.The uptakes of 18F-FDG in≥37 weeks group were found to be significantly higher than those in≤32 weeks group（P0.01）.The cerebral glucose metabolism was significantly changed in neonatal HIE as measured by 18F-FDG PET.The cerebral uptake of 18F-FDG was either unbalanced bilaterally or relatively low in all sites especially in subcortical alba,thalamus,basal ganglia in HIE pat

关 键 词：正电子发射断层显像术 婴儿 新生 缺氧缺血 脑 

分 类 号：R722.1[医药卫生—儿科]