MRI弥散加权成像联合脐血血气分析在缺氧缺血性脑病新生儿预后预测中的研究  

Application of MRI-DWI combined with blood gas analysis for umbilical cord blood in predicting the prognosis of neonates with hypoxic-ischemic encephalopathy

作　　者：王海天 王兰 秦伟[1] Wang Haitian;Wang Lan;Qin Wei(Department of Radiology,Qingdao Eighth People's Hospital,Qingdao 266121,China;Department of Neurology,Qingdao Eighth People's Hospital,Qingdao 266121,China)

机构地区：[1]青岛市第八人民医院放射科,青岛266121 [2]青岛市第八人民医院神经内科,青岛266121

出　　处：《中国医学装备》2025年第2期70-76,共7页China Medical Equipment

基　　金：山东省医药卫生科技发展计划(2022WS408)。

摘　　要：目的:探讨磁共振弥散加权成像(MRI-DWI)联合脐血血气分析预测缺氧缺血性脑病(HIE)新生儿预后。方法:回顾性分析2021年1月至2024年5月青岛市第八人民医院200例接受MRI-DWI检查及脐血血气检测的HIE新生儿基线资料,根据预后情况将其分为预后不良组(61例)和预后良好组(139例)。将两组有显著差异基线资料部分纳入logistic回归模型,分析影响发生预后不良的因素,运用受试者工作特征(ROC)曲线分析影响因素对发生预后不良的预测效能。结果:两组新生儿各部位的表观弥散系数(ADC)值(半卵圆中心、尾状核、豆状核、内囊前肢、内囊膝部、背侧丘脑)和脐血血气相关指标(pH值、氧分压、二氧化碳分压、碳酸氢根)比较差异均有统计学意义(t=-3.167、-4.929、-4.826、-4.489、2.648、-5.511、-5.048、-5.829、2.311、-4.484,P<0.05)。多因素logistic回归模型分析显示,豆状核、内囊前肢、内囊膝部、背侧丘脑的ADC值大、pH值大、氧分压大以及碳酸氢根水平高是影响HIE新生儿发生预后不良的保护因素(OR=0.007、0.014、0.099、0.000、0.078、0.371、0.781,P<0.05)。以ROC曲线分析显示,豆状核、内囊前肢、内囊膝部、背侧丘脑的ADC值、pH值、氧分压、碳酸氢根和联合预测的曲线下面积(AUC)分别为0.691、0.728、0.612、0.742、0.689、0.746、0.673和0.931。当取截断值(cut-off)值1.10,1.20,1.19,1.16,6.89,13.90,18.73时分别对应豆状核、内囊前肢、内囊膝部、背侧丘脑的ADC值、pH值、氧分压、碳酸氢根的灵敏度分别为0.532、0.863、0.770、0.568、0.597、0.741、0.568,特异度分别为0.770、0.623、0.475、0.951、0.754、0.672、0.754,而联合预测灵敏度为0.878和特异度为0.869。结论:豆状核、内囊前肢、内囊膝部和背侧丘脑ADC值越大、pH值越大、氧分压越大以及碳酸氢根水平越高为影响HIE新生儿发生预后不良的保护因素。这些指标对HIE新生儿发生预后不良Objective:To explore the application of magnetic resonance imaging-diffusion weighted imaging(MRI-DWI)combined with blood gas analysis for umbilical cord blood in predicting the prognosis of neonates with hypoxic-ischemic encephalopathy(HIE).Methods:A retrospective analysis was conducted on the baseline data of 200 HIE neonates who underwent MRI-DWI combined with blood gas testing for umbilical cord blood at Qingdao Eighth People's Hospital from January 2021 to May 2024.The neonates were divided into two groups based on their prognosis:poor prognosis group(61 cases)and good prognosis group(139 cases).The baseline data with significant differences between the two groups were included in the logistic regression model to analyze the factors of affecting the occurrence of poor prognosis.The predictive efficacy of the influence factors on the occurrence of poor prognosis was analyzed by using the receiver operating characteristic(ROC)curve.Results:There were statistically significant differences in the apparent diffusion coefficient(ADC)values of various regions(semioval center,caudate nucleus,lentiform nucleus,anterior limb of internal capsule,genu of internal capsule,and dorsal thalamus)and blood gas-related indicators of umbilical cord blood(pH value,oxygen partial pressure,carbon dioxide partial pressure,bicarbonate)between the two groups(t=-3.167,-4.929,-4.826,-4.489,2.648,-5.511,-5.048 and-5.829 and 2.311,-4.484,P<0.05).Multivariate logistic regression analysis showed that higher ADC values in the lentiform nucleus,anterior limb of internal capsule,genu of internal capsule,and dorsal thalamus,as well as higher pH values,oxygen partial pressure,and bicarbonate levels,were protective factors against poor prognosis of HIE neonates(OR=0.007,0.014,0.099,0.000,0.078,0.371,0.781,P<0.05).ROC curve analysis showed that the area under curve(AUC)values of the ADC values of the lentiform nucleus,anterior limb of internal capsule,genu of internal capsule and dorsal thalamus,pH value,oxygen partial pressure,bicarbonate,and co

关 键 词：磁共振弥散加权成像(MRI-DWI) 脐血血气分析 缺氧缺血性脑病(HIE) 影响因素 预后预测 

分 类 号：R445.2[医药卫生—影像医学与核医学]