大脑中动脉经颅多普勒超声血流动力学参数及血清netrin-1水平对HIE患儿疾病转归的预测价值  

Predictive Value of Middle Cerebral Artery Transcranial Doppler Ultrasound Hemodynamic Parameters and Serum Netrin-1 Level on Disease Outcome in Children with HIE

作　　者：杨晓峰 王应云[2] 王利芳 YANG Xiaofeng;WANG Yingyun;WANG Lifang(Department of Ultrasound,the First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471000,China;Department of Paediatrics,the First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471000,China)

机构地区：[1]河南科技大学第一附属医院超声科,河南洛阳471000 [2]河南科技大学第一附属医院儿科,河南洛阳471000

出　　处：《河南医学研究》2025年第3期432-436,共5页Henan Medical Research

摘　　要：目的探究大脑中动脉(MCA)经颅多普勒超声血流动力学参数及血清神经轴突导向因子1(netrin-1)水平与新生儿缺血缺氧性脑病(HIE)患儿疾病转归的预测价值。方法收集2021年12月至2023年8月于河南科技大学第一附属医院就诊的108例HIE患儿,根据治疗后是否有效可将其分为良好组(78例)、不良组(30例),比较两组一般资料及MCA经颅多普勒超声血流动力学参数[阻力指数(RI)、舒张末期流速(Vd)、收缩期峰值流速(Vs)、平均血流速度(Vm)]、血清netrin-1水平,分析HIE预后不良的影响因素,采用Spearman法、受试者工作特征(ROC)曲线分析相关性及联合预测价值。结果不良组无早期干预、病情程度为重度、10 min Apgar评分≥4分中的占比大于良好组(P<0.05);良好组Vd、Vs、Vm及血清netrin-1水平高于不良组,RI值低于不良组(P<0.05);Vd、Vs、Vm、RI、血清netrin-1水平、无早期干预、病情程度、10 min Apgar评分均为HIE患儿预后不良的影响因素(P<0.05);Vd、Vs、Vm及血清netrin-1与预后情况均呈负相关,RI值与预后情况呈正相关(P<0.05);Vd、Vs、Vm、RI、血清netrin-1水平联合预测HIE患儿预后不良的AUC为0.864,最佳预测敏感度为93.33%,特异度为79.49%。结论MCA经颅多普勒超声血流动力学参数及血清netrin-1水平可作为临床预测HIE患儿预后情况的辅助指标,两项检查联合检测可显著提高预测效能。Objective To explore the predictive value of transcranial Doppler ultrasound hemodynamic parameters of middle cerebral artery(MCA)and serum netrin-1 level in the prognosis of neonatal hypoxic ischemic encephalopathy(HIE).Methods A total of 108 children with HIE in the First Affiliated Hospital of Henan University of Science and Technology from December 2021 to August 2023 were collected and divided into good group(78 cases)and bad group(30 cases)according to whether the treatment was effective or not.The general data,MCA hemodynamic parameters[resistance index(RI),end diastolic velocity(Vd),peak systolic velocity(Vs),mean flow velocit(Vm)]and serum netrin-1 levels of the two groups were compared,and the influencing factors of poor prognosis of HIE were analyzed.The correlation and combined predictive value were analyzed by Spearman method and receiver operating characteristic(ROC)curve.Results The proportion of patients with no early intervention,severe disease and 10 min Apgar score≥4 in the adverse group was higher than that in the good group(P<0.05).The levels of Vd,Vs,Vm and serum netrin-1 in the good group were higher than those in the bad group,and the RI value was lower than that in the bad group(P<0.05).Vd,Vs,Vm,RI,serum netrin-1 level,no early intervention,disease severity,and 10 min Apgar score were the influencing factors of poor prognosis in children with HIE(P<0.05).Vd,Vs,Vm and serum netrin-1 were negatively correlated with prognosis,while RI was positively correlated with prognosis(P<0.05).The AUC of combining Vd,Vs,Vm and serum netrin-1 level to predict the poor prognosis of HIE children was 0.864,the best predictive sensitivity was 93.33%,and the specificity was 79.49%.Conclusion MCA transcranial Doppler ultrasound hemodynamic parameters and serum netrin-1 level can be used as auxiliary indicators to predict the prognosis of HIE children,and the combined predictive of the two tests can significantly improve the prediction efficiency.

关 键 词：缺血缺氧性脑病 大脑中动脉 经颅多普勒超声 神经轴突导向因子1 联合预测 

分 类 号：R445[医药卫生—影像医学与核医学]