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目的探讨足月缺氧缺血性脑病(HIE)患儿1 H-MRS与NBNA评分的相关性。方法纳入足月HIE患儿101例,29例日龄≤3天、33例日龄4~7天、39例日龄8~14天;另选取同期足月健康新生儿37名作为正常对照。行常规MR及1 H-MRS检查,根据MRI表现对HIE进行分级,比较不同程度HIE患儿和正常新生儿N-乙酰天门冬氨酸(NAA)/胆碱复合物(Cho)、NAA/肌酸(Cr)及Cho/Cr差异;对HIE患儿行新生儿行为神经测定(NBNA)评分,比较不同程度HIE患儿NBNA评分差异;评价1 H-MRS指标与NBNA评分的相关性。结果≤3天重度HIE患儿,4~7天和8~14天中、重度患儿基底节NAA/Cho低于相应日龄正常新生儿(P均<0.05),所有日龄中、重度HIE患儿基底节NAA/Cr和额叶NAA/Cho均低于相应日龄正常新生儿(P均<0.05);≤3天和8~14天不同程度HIE患儿间基底节NAA/Cho、4~7天不同程度HIE患儿间额叶NAA/Cho差异有统计学意义(P均<0.05)。不同日龄重度HIE患儿NBNA评分均低于中度HIE患儿(P均<0.05)。HIE患儿基底节NAA/Cho和NAA/Cr、额叶NAA/Cho与NBNA评分呈正相关(r=0.238,0.221,0.202;P均<0.05)。结论 HIE患儿1 H-MRS与NBNA评分具有相关性,二者结合有助于早期检出足月儿HIE及评价脑损伤严重程度。
Objective To investigate the correlation between 1 H-MRS and NBNA in children with full-term hypoxic-ischemic encephalopathy (HIE). Methods A total of 101 full-term neonates with HIE were enrolled. Twenty-nine children (≤ 3 days old), 33 children aged 4 to 7 days and 39 children aged 8 to 14 days were enrolled. Thirty-seven full-term healthy newborns were selected as normal controls. HMR was graded according to MRI findings by routine MR and 1 H-MRS examinations. NAA / Cho and NAA were compared between children with HIE and normal neonates. Acidosis (Cr) and Cho / Cr difference; neonatal behavioral neurological assessment (NBNA) score in children with HIE, NBNA score differences in children with different levels of HIE; evaluation of 1 H-MRS index and NBNA score correlation. Results In children with severe HIE less than 3 days, the basal ganglion NAA / Cho of severe HIE children were lower than those of the corresponding normal infants (P <0.05) on day 4-7 and day 8-14. All the moderate to severe HIE NAA / Cr in basal ganglion and NAA / Cho in frontal lobe of children with HIE were significantly lower than those of corresponding normal neonates (all P <0.05). NAA / Cho of basal ganglia in children with HIE less than 3 days and 8-14 days There was significant difference of NAA / Cho between the frontal lobe and the level of HIE in all 7 ~ 7 days (all P <0.05). The NBNA scores of children with severe HIE at different ages were lower than those with moderate HIE (all P <0.05). NAA / Cho and NAA / Cr in basal ganglia and NAA / Cho in frontal lobe were positively correlated with NBNA score (r = 0.238,0.221,0.202; P <0.05). Conclusions There is a correlation between 1 H-MRS and NBNA score in children with HIE. The combination of the two can be helpful for early detection of full-term HIE and evaluation of the severity of brain injury.