磁共振波谱对先天性心脏病新生儿神经系统发育异常的早期预测价值  

Predictive value of ^(1)H-magnetic resonance spectroscopy on the nervous system dysplasia in neonates with congenital heart disease

作　　者：李鸣鹤[1] 胡海华 Li Minghe;Hu Haihua(Department of Radiology,Huzhou First People's Hospital,Huzhou 313000,China;Department of Nuclear Medicine,Mingzhou Hospital of Huzhou,North Zhejiang,Huzhou 313000,China)

机构地区：[1]浙江省湖州市第一人民医院放射科,313000 [2]浙江省湖州浙北明州医院核医学科,313000

出　　处：《心脑血管病防治》2021年第5期472-475,共4页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

摘　　要：目的探讨磁共振波谱对诊断先天性心脏病(CHD)新生儿神经系统发育异常的早期预测价值。方法选取2018年1月至2019年12月湖州市第一人民医院收治的CHD新生儿60例,根据是否出现神经系统发育异常分为正常组与异常组各30例,分别对两组新生儿的两侧脑室前、后角旁白质区(WM)和基底节区及丘脑(BGT)进行氢质子磁共振波谱(1H-MRS)图像采集,计算脑内代谢物N-乙酰天门冬氨酸(NAA)/肌酸复合物(Cr)、胆碱复合物(Cho)/Cr、乳酸(Lac)/Cr的值;并于入院后对两组新生儿进行Gesell发育诊断量表检测,计算发育商(DQ);同时对各代谢物比值与DQ之间作相关性分析;利用ROC曲线分析代谢产物对神经系统发育异常的预测能力。结果在BGT区域和WM区域,异常组新生儿的NAA/Cr均低于正常组,差异具有统计学意义(t=-5.102、-6.582,P<0.05);Cho/Cr和Lac/Cr均高于正常组,差异具有统计学意义(t=2.421、13.004、3.244、26.421,P<0.05)。Spearman相关性分析显示NAA/Cr、Cho/Cr、Lac/Cr与DQ之间具有相关性,BGT区域NAA/Cr与DQ呈正相关(r=0.813,P<0.01),Cho/Cr、Lac/Cr与DQ呈负相关(r=-0.747、-0.630,P<0.01),WM区域NAA/Cr与DQ呈正相关(r=0.721,P<0.01),Cho/Cr、Lac/Cr与DQ呈负相关(r=-0.575、-0.487,P<0.01)。BGT区域NAA/Cr、Cho/Cr对神经系统发育异常预测价值高,曲线下面积(AUC)分别为0.946(95%CI=0.828~0.988)、0.954(95%CI=0.846~0.997)。结论CHD患儿早期^(1)H-MRS检测的脑内代谢物与发育商之间具有相关性,代谢物的测定对诊断CHD患儿神经系统发育异常具有早期预测价值。Objective To investigate the predictive value of 1H-magnetic resonance spectroscopy(1H-MRS)on the diagnosis of nervous system dysplasia in neonates with congenital heart disease(CHD).Methods Totally 60 neonates with CHD who were treated in Huzhou First People's Hospital from January 2018 to December 2019 were selected,according to whether there was abnormal development of nervous system,patients were divided into normal group and abnormal group,30 in each group.The 1H-MRS images of the periventricular white matter(WM),basal ganglia and thalamus(BGT)were detected.The ratio of N-acetylaspartic acid(NAA)/creatine(Cr),choline(Cho)/Cr,lactic acid(Lac)/Cr were calculated.The Gesell Developmental Diagnostic Scale examination was performed after admission to hospital,the values of the development quotient(DQ)were calculated.The correlations between the brain metabolites and DQ were analyzed;and the predictive values of brain metabolites for nervous system dysplasia were evaluated by using ROC curve.Results In BGT and WM regions,the NAA/Cr of neonates in abnormal group was lower than that in normal group,the differences were statistically significant(t=-5.102,-6.582;P<0.05);Cho/Cr,Lac/Cr were significantly higher than those in the normal group(t=2.421,13.004,3.244,26.421;P<0.05).The analysis of Spearman correlation demonstrated that DQ had significant correlations with NAA/Cr,Cho/Cr and Lac/Cr,and NAA/Cr in BGT region was positively correlated with DQ(r=0.813,P<0.01),CHO/Cr,lac/Cr in BGT region were negatively correlated with DQ(r=-0.747,-0.630;P<0.01),NAA/Cr in WM area was positively correlated with DQ(r=0.721,P<0.01),CHO/Cr,lac/Cr in WM area were negatively correlated with DQ(r=-0.575,-0.487;P<0.01).NAA/Cr and Cho/Cr in BGT region had high predictive value for abnormal nervous system development,the area under curve(AUC)is 0.946(95%CI=0.828~0.988),0.954(95%CI=0.846~0.997)respectively.Conclusion There is significant correlation between the brain metabolites detected by the early 1H-MRS and DQ in the CHD neonates,the dete

关 键 词：先天性心脏病 磁共振波谱 脑代谢 神经系统异常 

分 类 号：R725.4[医药卫生—儿科]