多模态磁共振成像预测新生儿缺氧缺血性脑病预后的价值分析

doi:10.3760/cma.j.cn441417-20240910-01018

摘要/Abstract

摘要：

目的　分析多模态磁共振成像（MRI）对新生儿缺氧缺血性脑病（HIE）预后的预测价值。方法　选取2022年1月至2023年12月驻马店市中心医院收治的HIE新生儿78例作为HIE组，其中预后良好（Gesell发育量表评分>75分）新生儿49例，预后不良（Gesell发育量表评分≤75分）新生儿29例。并以1∶1配比选取同期有窒息史但无脑损伤的新生儿78例作为非HIE组。HIE组中男40例，女38例；日龄（4.02±1.38）d；胎龄（39.25±0.75）周；头围（32.05±0.71）cm；分娩方式：顺产21例，剖宫产57例。非HIE组中男42例，女36例；日龄（4.06±1.35）d；胎龄（39.19±0.72）周；头围（32.01±0.64）cm；分娩方式：顺产24例，剖宫产54例。所有新生儿均行多模态MRI检查。比较两组新生儿、不同预后HIE新生儿的多模态MRI参数（纵向弛豫时间、表观弥散系数、脑血流量）。分析多模态MRI参数与HIE患儿预后的相关性。采用独立样本t检验、χ²检验、Spearman相关性分析进行统计学分析。结果　HIE组新生儿纵向弛豫时间、表观弥散系数、脑血流量分别为（1 436.85±23.69）ms、（1.18±0.11）×10^-3mm²/s、（27.59±2.02）ml/（100 g·min），非HIE组新生儿上述指标分别为（1 145.02±15.28）ms、（2.09±0.21）×10^-3mm²/s、（16.03±1.24）ml/（100 g·min），差异均有统计学意义（t=91.428、33.902、43.074，均P<0.001）。预后良好HIE新生儿的纵向弛豫时间、表观弥散系数、脑血流量分别为（1 386.47±20.02）ms、（1.32±0.15）×10^-3mm²/s、（23.02±1.86）ml/（100 g·min），预后不良HIE新生儿上述指标分别为（1 804.35±26.75）ms、（0.81±0.07）×10^-3mm²/s、（34.96±2.37）ml/（100 g·min），差异均有统计学意义（t=78.460、17.201、23.708，均P<0.001）。Spearman分析结果显示，纵向弛豫时间、脑血流量均与HIE新生儿预后不良呈正相关（r=0.837、0.840，均P<0.001），表观弥散系数与HIE新生儿预后不良呈负相关（r=-0.837，P<0.001）。结论　HIE新生儿的多模态MRI参数与非HIE新生儿存在明显差异，且多模态MRI参数能预测HIE新生儿的预后情况。

关键词:

缺氧缺血性脑病, 新生儿, 多模态磁共振成像, 预后

Abstract:

Objective　To analyze the prognostic value of multimodal magnetic resonance imaging (MRI) in neonatal hypoxic-ischemic encephalopathy (HIE). Methods　Seventy-eight neonates with HIE in Zhumadian Central Hospital from January 2022 to December 2023 were selected as a HIE group, of whom 49 had a good prognosis (Gesell development scale score >75 points) and 29 had a poor prognosis (Gesell development scale score ≤75 points). A total of 78 neonates with asphyxia history but without brain injury during the same period were selected as a non-HIE group, and all of them underwent multimodal MRI. There were 40 boys and 38 girls in the HIE group, aged (4.02±1.38) days; the gestational age was (39.25±0.75) weeks; the head circumference was (32.05±0.71) cm; the delivery methods were natural delivery in 21 cases and cesarean section in 57 cases. There were 42 boys and 36 girls in the non-HIE group, aged (4.06±1.35) days; the gestational age was (39.19±0.72) weeks; the head circumference was (32.01±0.64) cm; the delivery methods were natural delivery in 24 cases and cesarean section in 54 cases. The multimodal MRI parameters of the two groups and the multimodal MRI parameters of HIE neonates with different prognosis were compared, and the correlations between the multimodal MRI parameters and prognosis were analyzed. Independent sample t test, χ² test, and Spearman correlation analysis were used for statistical analysis. Results　In the HIE group, the T₁, apparent diffusion coefficient, and cerebral blood flow were (1 436.85±23.69) ms, (1.18±0.11) ×10^-3 mm²/s, (27.59±2.02) ml/ (100 g·min), and those in the non-HIE group were (1 145.02±15.28) ms, (2.09±0.21) ×10^-3 mm²/s, and (16.03±1.24) ml/ (100 g·min), with statistically significant differences (t=91.428, 33.902, and 43.074, all P<0.001). The levels of T₁ and cerebral blood flow in neonates with poor prognosis were higher than those in neonates with good prognosis [(1 804.35±26.75) ms vs. (1 386.47±20.02) ms, (34.96±2.37) ml/ (100 g·min) vs. (23.02±1.86) ml/ (100 g·min)], and the apparent diffusion coefficient was lower than that in neonates with good prognosis [(0.81±0.07) ×10^-3 mm²/s vs. (1.32±0.15) ×10^-3 mm²/s], with statistically significant differences (t=78.460, 23.708, and 17.201, all P<0.001). Spearman analysis showed that T₁ and cerebral blood flow were positively correlated with poor prognosis of HIE neonates (r=0.837 and 0.840, both P<0.001), and apparent diffusion coefficient was negatively correlated with poor prognosis of HIE neonates (r=-0.837, P<0.001). Conclusion　There are significant differences in the multimodal MRI parameters between HIE neonates and non-HIE neonates, and the multimodal MRI parameters can predict the prognosis of HIE neonates , providing a reference for clinical diagnosis and evaluation of treatment effect.

Key words:

Hypoxic-ischemic encephalopathy, Neonates, Multimodal magnetic resonance imaging, Prognosis

董思颖李俊超闫松.

多模态磁共振成像预测新生儿缺氧缺血性脑病预后的价值分析 [J]. 国际医药卫生导报, 2025, 31(1): 84-88.

Dong Siying, Li Junchao, Yan Song.

Analysis of the predictive value of multimodal magnetic resonance imaging on the prognosis of neonatal hypoxic-ischemic encephalopathy [J]. International Medicine and Health Guidance News, 2025, 31(1): 84-88.

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