足月新生儿低血糖22例磁共振表现与临床特征  

The relationship between the MRI findings and clinical features in 22 full-term infants with neonatal hypoglycemia

作　　者：顾秋芳[1] 胡黎园[1] 陈超[1] 曹云[1] 邵肖梅[1] 程国强[1] 王来栓[1] 朱珍[1] 周文浩[1] 

机构地区：[1]复旦大学附属儿科医院,上海201102

出　　处：《中国循证儿科杂志》2013年第2期116-121,共6页Chinese Journal of Evidence Based Pediatrics

基　　金：上海市卫生局课题:新生儿低血糖脑损伤的MRI研究(2008192)

摘　　要：目的探讨足月新生儿低血糖病例的MRI表现及临床特征的相关性。方法回顾性分析2008年6月1日至2011年6月30日复旦大学附属儿科医院新生儿科收治的22例足月低血糖新生儿的病例资料,根据MRI检查结果分为低血糖MRI-组(n=9)和低血糖MRI+组(n=13),分析两组低血糖新生儿的临床特征并描述低血糖MRI+组的MRI表现。结果 MRI-组和MRI+组在有无围生期高危因素中的差异无统计学意义(P=0.054);MRI-组和MRI+组低血糖首次发现时间分别为1(0.5～17)h和46.6(12.7～78.3)h,两组差异有统计学意义P=0.000;MRI-组和MRI+组血糖正常并稳定的时间分别为(54.1±18.2)h和(71.6±15.1)h,两组差异有统计学意义P=0.023。出现症状的比例MRI+组高于MRI-组(P=0.000)。MRI+组中10例低血糖新生儿的MRI表现以累及双侧枕顶叶为主,3例不伴双侧枕顶叶损伤(1例累及单侧顶枕叶,2例为侧脑室旁和半卵圆中心斑点状白质损伤)。结论对于存在高危因素的低血糖新生儿,应早期筛查,定期监测;生后12h内发现的低血糖新生儿可无症状,MRI可无脑损伤性改变;血糖正常并稳定的时间指标提示对低血糖脑损伤更要注意远期随访。双侧顶枕叶是新生儿低血糖脑损伤的主要受累部位。Objective To evaluate the relationship between the MRI findings and clinical characteristics in full-term infants with neonatal hypoglycemia. Methods The clinical records of 22 neonates with isolated hypoglycemia who were referred to Children＇ Hospital of Fudan University from June 1, 2008 to June 30, 2011 were reviewed retrospectively. The patients were divided into two groups according to the early magnetic resonance imaging （MRI） findings： MRI -group （n = 9 ） were patients who showed normal brain imaging while MRI ＋ group （ n = 13 ） were patients who showed abnormal brain imaging finding. The clinical characteristics of neonatal hypoglycemia were compared between two groups. The brain injury patterns identified from early MRI scans were presented. Results The frequencies of risk factors for hypoglycemia were similar in two groups （ P = O. 054）. The duration when hypoglycemia was first detected was 1 （0.5 - 17 ） h in MRI - group and 46.6 （ 12.7 - 78.3 ） h in MRI ＋ group, respectively, P =0.000. MRI - group established stable blood glucose levels faster than the MRI ＋ group, （54.1 ± 18.2） h vs （71.6±15.1） h, P =0. 023. The occurrences of symptoms were more frequent in MRI ＋ group than MRI - group （P = 0. 000）. Among MRI ＋ group, 10 had predominant bilateral parieto-occipital cortex and subcortieal white matter abnormalities, 1 had unilateral occipital and parietal area lesions, 2 had punetate white matter lesions in periventricular region or centrnm semiovale. Conclusions Screening and management of babies at risk for neonatal hypoglycemia are recommended. Infants who were identified less than 12 hours of postnatal age remained asymptomatic, and there were no changes in the MRI imaging. The duration from birth till establishment of the stable blood glucose levels might be suggestive of association with neuroimaging changes and long- term neurological changes. The most common area of hypoglycemia-associated brain injury was in the parietal and occipital lobes.

关 键 词：低血糖 新生儿 脑损伤 磁共振成像 

分 类 号：R722.1[医药卫生—儿科]