豆状核区^(1)H-MR波谱代谢物比值诊断新生儿缺氧缺血性脑病  

^(1)H-MR spectroscopy metabolite ratio of lenticular nucleus for diagnosing neonatal hypoxic ischemic encephalopathy

作　　者：盛会雪 席艳丽[1] 王瑞珠 杨明[1] 高峰[1] SHENG Huixue;XI Yanli;WANG Ruizhu;YANG Ming;GAO Feng(Department of Radiology,Children's Hospital of Nanjing Medical University,Nanjing 210008,China)

机构地区：[1]南京医科大学附属儿童医院放射科,江苏南京210008

出　　处：《中国医学影像技术》2022年第5期658-662,共5页Chinese Journal of Medical Imaging Technology

摘　　要：目的观察豆状核区^(1)H-MR波谱(^(1)H-MRS)代谢物比值诊断新生儿缺氧缺血性脑病(HIE)的价值。方法将78例HIE足月新生儿分为轻度组(n=42)和中重度组(n=36),以同期20例非HIE的其他疾病足月新生儿作为对照组;TE分别取35、135 ms行头颅^(1)H-MRS,检测豆状核区代谢物N-乙酰天门冬氨酸(NAA)、胆碱复合物(Cho)、肌酸(Cr)及乳酸(Lac)水平,计算NAA/Cr、Cho/Cr、NAA/Cho、Lac/Cr、Lac/Cho及Lac/NAA比值。比较3组间各代谢物比值,分析其与血清神经元特异性烯醇化酶(NSE)和乳酸脱氢酶(LDH)的相关性,观察其诊断HIE的效能。结果TE为35 ms时,3组Lac/Cr、Lac/Cho及Lac/NAA差异均有统计学意义(P均<0.05);轻度组Lac/Cr、Lac/Cho及Lac/NAA均低于中重度组(P均<0.05)而高于对照组(P均<0.05)。TE为135 ms时,3组NAA/Cr及NAA/Cho差异均有统计学意义(P均<0.05);轻度组NAA/Cr及NAA/Cho均高于中重度组(P均<0.05)而低于对照组(P均<0.05)。TE为35 ms时,血清LDH与Lac/Cho呈弱正相关(r=0.280,P=0.008),与Lac/Cr及Lac/NAA呈低度正相关(r=0.325,P=0.002;r=0.414,P<0.001);TE为135 ms时,血清NSE与NAA/Cr呈中度负相关(r=-0.584,P<0.001),与NAA/Cho呈高度负相关(r=-0.857,P<0.001)。TE取135 ms时,NAA/Cho诊断新生儿HIE的曲线下面积均大于血清NSE及LDH(Z=2.481、2.713,P均<0.05),以NAA/Cho=0.56为最佳截断值,其诊断敏感度为93.54%,特异度为66.12%。结论豆状核区^(1)H-MRS代谢物比值有助于诊断新生儿HIE,TE取135 ms时NAA/Cho诊断效能较佳。Objective To observe the value of^(1)H-MR spectroscopy(^(1)H-MRS)metabolite ratio of lenticular nucleus for diagnosing neonatal hypoxic ischemic encephalopathy(HIE).Methods Totally 78 full-term neonates with HIE were enrolled and divided into mild group(n=42)and moderate-severe group(n=36).Meanwhile,20 full-term non-HIE neonates with other diseases were selected as controls(control group).The level of N-acetylaspartic(NAA),choline(Cho),creatine(Cr)and lactic acid(Lac)in lenticular nucleus were measured with^(1)H-MRS when TE were 35 and 135 ms,respectively.The ratio of NAA/Cr,Cho/Cr,NAA/Cho,Lac/Cr,Lac/Cho and Lac/NAA were calculated and compared among 3 groups,and the correlations with serum neuron specific enolase(NSE)and lactate dehydrogenase(LDH)were analyzed to observe efficacies for diagnosing HIE.Results When TE was 35 ms,significant differences of Lac/Cr,Lac/Cho and Lac/NAA were found among 3 groups(all P<0.05),and Lac/Cr,Lac/Cho and Lac/NAA in mild group were lower than those in moderate-severe group but higher than those in control group(all P<0.05).When TE was 135 ms,there were significant differences of NAA/Cr and NAA/Cho among 3 groups(all P<0.05),and NAA/Cr and NAA/Cho in mild group were higher than those in moderate-severe group but lower than those in control group(all P<0.05).When TE was 35 ms,serum LDH was weakly and positively correlated with Lac/Cho(r=0.280,P=0.008),lowly and positively correlated with Lac/Cr and Lac/NAA(r=0.325,P=0.002;r=0.414,P<0.001).When TE was 135 ms,serum NSE was moderately and negatively correlated with NAA/Cr(r=-0.584,P<0.001)and highly and negatively correlated with NAA/Cho(r=-0.857,P<0.001).When TE was 135 ms,the area under the curve of NAA/Cho for diagnosing neonatal HIE was greater than those of serum NSE and LDH(Z=2.481,2.713,both P<0.05).Taken NAA/Cho was 0.56 as the best cut-off value,the sensitivity was 93.54%and the specificity was 66.12%.Conclusion^(1)H-MRS metabolite ratio of lenticular nucleus was helpful for diagnosing neonatal HIE,and the diagnostic efficac

关 键 词：婴儿 新生儿 缺氧缺血 脑 磷酸丙酮酸水合酶 乳酸脱氢酶 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]