颅脑单体素MR波谱诊断足月新生儿高胆红素血症及急性胆红素脑病  

Single voxel MR spectroscopy of brain for diagnosing neonatal hyperbilirubinemia and acute bilirubin encephalopathy

作　　者：赖伟 徐凤丹 黎倩仪 范淼[4] 梁润球 吴婷婷 李登辉 李宁 刘建新 LAI Wei;XU Fengdan;LI Qianyi;FAN Miao;LIANG Runqiu;WU Tingting;LI Denghui;LI Ning;LIU Jianxin(Department of Radiology,Dongguan Children's Hospital,Dongguan 523325,China;Department of Neonatal Intensive Care Unit,Dongguan Children's Hospital,Dongguan 523325,China;Teaching and Research Section of Pediatrics,Guangdong Medical University,Dongguan 523808,China;Department of Radiology,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]东莞市儿童医院(东莞市第八人民医院)放射科,广东东莞523325 [2]东莞市儿童医院(东莞市第八人民医院)新生儿重症监护室,广东东莞523325 [3]广东医科大学儿科学教研室,广东东莞523808 [4]中山大学附属第一医院放射科,广东广州510080

出　　处：《中国医学影像技术》2021年第10期1446-1451,共6页Chinese Journal of Medical Imaging Technology

基　　金：东莞市社会科技发展(一般)项目(201950715028857);广东医科大学科研基金立项资助项目(M2017022)。

摘　　要：目的观察颅脑单体素MR波谱(MRS)用于诊断足月新生儿高胆红素血症(NHB)及急性胆红素脑病(ABE)的价值。方法收集70例因各种疾病而接受MRS的新生儿,按血清总胆红素(TBIL)峰值水平分为正常对照组(B0组,n=7)、轻度NHB组(B1组,n=6)、中度NHB组(B2组,n=22)、重度NHB组(B3组,n=22)和极重度NHB组(B4组,n=13);根据有无急性胆红素脑病(ABE)分为ABE组(n=16)和无ABE组(n=54)。计算各组代谢产物肌酸(Cr)、N-乙酰天冬氨酸(NAA)、胆碱(Cho)、谷氨酰胺和谷氨酸(Glx)及肌醇(MI)的绝对浓度和NAA/Cr、Cho/Cr、Glx/Cr及MI/Cr比值,分析组间NAA/Cr、Cho/Cr、Glx/Cr和MI/Cr差异;绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),观察各代谢产物诊断NHB和ABE的效能。结果Cho/Cr、Glx/Cr和MI/Cr总体差异均有统计学意义(P均<0.05)。B3与B1、B2组间Cho/Cr差异均有统计学意义(P均<0.05);B0与B1、B2、B3、B4组间,B1与B3、B4组间,B2与B3、B4组间Glx/Cr,B0与B3、B4组间,B2与B3、B4组间MI/Cr差异均有统计学意义(P均<0.05)。NHB严重程度与Glx/Cr呈强正相关(r=0.60,P<0.001),与MI/Cr呈弱正相关(r=0.33,P<0.01),而与Cho/Cr无明显相关性(r=0.17,P=0.16)。根据Glx/Cr于B1及以上组和B2及以上组诊断NHB的AUC均大于MI/Cr(P均<0.05),无ABE组和ABE组间Glx/Cr差异有统计学意义(P<0.05);Glx/Cr以1.79为截断值时,诊断ABE的AUC为0.70,敏感度为87.50%,特异度为57.41%。结论颅脑单体素MRS可通过定量分析各代谢物诊断新生儿NHB,以Glx/Cr的诊断效能最高,Glx/Cr≥1.79提示存在ABE风险。Objective To observe the value of brain single voxel MR spectroscopy(MRS)for diagnosis of neonatal hyperbilirubinemia(NHB)and acute bilirubin encephalopathy(ABE).Methods Totally 70 newborns who underwent MRS were enrolled and divided into normal control group(B0 group,n=7),mild NHB group(B1 group,n=6),moderate NHB group(B2 group,n=22),severe NHB group(B3 group,n=22)and extremely severe NHB group(B4 group,n=13)according to the peak level of serum total bilirubin(TBIL),also into ABE group(n=16)or non-ABE group(n=54)according to with or without ABE.The absolute concentrations of creatine(Cr),N-acetyl aspartate(NAA),choline(Cho),glutamine and glutamate(GLx)and myo-inositol(MI),as well as the ratios of NAA/Cr,Cho/Cr,Glx/Cr and MI/Cr were calculated.NAA/Cr,Cho/Cr,Glx/Cr and MI/Cr were compared among groups.The receiver operating characteristic(ROC)curve was drawn,and the area under the curve(AUC)was calculated to observe the efficacy of each metabolite for diagnosing NHB and ABE.Results Cho/Cr,Glx/Cr and MI/Cr were significantly different among 5 groups(all P<0.05).Significant differences were found of Cho/Cr between B3 and B1,B2 groups,of Glx/Cr between B0 and B1,B2,B3,B4 groups,B1 and B3,B4 groups,B2 and B3,B4 groups,as well as of MI/Cr between B0 and B3,B4 groups,B2 and B3,B4 groups(all P<0.05).There was a strong positive correlation between NHB severity and Glx/Cr(r=0.60,P<0.001),a weak positive correlation between NHB severity and MI/Cr(r=0.33,P<0.01),but no obvious correlation between NHB severity and Cho/Cr(r=0.17,P=0.16).The AUC of Glx/Cr for diagnosing NHB in≥B1 groups and≥B2 groups were significantly higher than that of MI/Cr(all P<0.05).There were significant differences of Glx/Cr between ABE group and non-ABE group(P<0.05).Taken 1.79 as the cut-off value,the AUC of Glx/Cr was 0.70,the sensitivity was 87.50%and the specificity was 57.41%.Conclusion Brain single voxel MRS could be used for diagnosis of NHB through quantitative analysis of metabolites,among which Glx/Cr had the highest diagnostic efficienc

关 键 词：婴儿 新生儿 高胆红素血症 核黄疸 磁共振波谱 

分 类 号：R722.1[医药卫生—儿科] R445.2[医药卫生—临床医学]