Abstract
目的 观察足月新生儿缺氧缺血性脑病(HIE)时的脑代谢改变,并探讨其与临床分度及预后的关系.方法 以9例无窒息的正常新生儿作为对照,对临床确诊的46例HIE患儿进行MRI及氢质子MR波谱(1H-MRS)检查,MRS采用单体素及二维多体素化学位移波谱技术.46例HIE临床分度包括轻度25例、中度11例以及重度10例.观察HIE患儿MRS代谢物变化及其与临床分度和预后的关系.结果 (1)HIE的典型表现为:乳酸(Lac)峰增高,谷氨酸及谷氨酰复合物α峰(GLx-α)增高及氮-乙酰天门冬氨酸(NAA)峰降低.(2)GLx-α/肌酸及磷酸肌酸(Cr)比值在对照组及HIE轻、中、重度组分别为0.16、0.21、0.64、1.31,GLx-α/Cr比值在对照组及HIE组差异有统计学意义(t=5.01,P＜0.01),且在HIE各组之间差异亦有统计学意义(F=63.29,P＜0.05).Lac/Cr比值在对照组及HIE轻、中、重度组分别为0.12、0.14、0.19、0.26,该比值在对照组及HIE组差异有统计学意义(t=2.78,P＜0.05),且在HIE各组之间差异亦有统计学意义(F=11.74,P＜0.05).GLx-α/Cr及Lac/Cr比值与临床分度呈正相关性(r=0.76及0.59,P均＜0.01).NAA/Cr比值在HIE重度组明显低于中、轻度组.(3)等级相关分析证明GLx-α/Cr及Lac/Cr比值与HIE预后呈负相关关系,尤其是GLx-α/Cr比值相关性更强(相关系数r=-0.83,P＜0.01),可作为评估HIE预后的有效指标.结论 1H-MRS技术可无创观察HIE患儿脑代谢改变,观察脑损伤严重程度及预后评估.HIE患儿基底节区GLx-α/Cr比值升高提示预后不良。
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