摘要
目的观察磁共振波谱(MRS)技术在早产儿脑白质损伤(WMD)中的应用价值。方法回顾性选取2020-08—2022-11南通市第一人民医院收治的240例WMD早产儿为WMD组,另选取同期200例无WMD等颅脑疾病的早产儿为非WMD组,所有早产儿均于出生后7 d与14 d行MRS检查,比较2组N-乙酰天门冬氨酸(NAA)、肌酸(Cr)、胆碱(Cho)、乳酸(Lac)代谢物浓度,采用受试者工作特征(ROC)曲线分析NAA、Cr、Cho、Lac对早产儿WMD的诊断价值,采用Pearson相关性分析NAA、Cr、Cho、Lac浓度与WMD组早产儿Gesell评分的关系。结果WMD组早产儿出生后7 d、14 d的NAA浓度低于非WMD组(P<0.05),Cr、Cho、Lac浓度高于非WMD组(P<0.05)。ROC曲线分析显示,出生后7 d与14 d MRS代谢指标NAA、Cr、Cho、Lac联合诊断早产儿WMD的AUC分别为0.857、0.844,特异性分别为93.00%、93.00%,均高于单一指标(P<0.05)。随访WMD组早产儿12个月发育情况显示,62例(25.83%)早产儿发育正常,60例(25.00%)发育边缘,118例(49.17%)发育落后;24月龄时,66例(27.50%)发育正常,68例(28.33%)发育边缘,106例(44.17%)发育落后。12月龄、24月龄时不同发育程度WMD早产儿出生7 d的NAA、Cr、Cho、Lac代谢物浓度比较差异有统计学意义(P<0.05)。与发育正常组比较,发育落后组与发育边缘组WMD早产儿NAA浓度更低,Cr、Cho、Lac浓度更高(P<0.05)。与发育边缘组比较,发育落后组WMD早产儿NAA浓度更低,Cr、Cho、Lac浓度更高(P<0.05)。Pearson相关性分析显示,WMD早产儿Gesell各项目评分与NAA浓度呈正相关,与Cr、Cho、Lac浓度呈负相关(P<0.05)。结论MRS对早产儿WMD的临床诊断价值较高,经MRS测定的NAA、Cr、Cho、Lac浓度均与WMD早产儿发育情况有相关性,可为早产儿WMD病情监测及预后评估提供依据。
Objective To observe the application value of magnetic resonance spectroscopy(MRS)in white matter damage(WMD)in premature infants.Methods Clinical data of 240 premature infants with WMD(WMD group)admitted to Nantong First People’s Hospital from August 2020 to November 2022 were retrospectively collected.Meanwhile,200 premature infants without craniocerebral diseases such as WMD were selected as non-WMD group.All premature infants underwent MRS on the 7th day and 14th day after birth.The concentrations of N-acetyl-aspartate(NAA),creatine(Cr),choline(Cho)and lactic acid(Lac)were compared between the two groups.Diagnostic value of NAA,Cr,Cho,and Lac for WMD in premature infants was analyzed using receiver operating characteristic(ROC)curves.Pearson correlation analysis was performed to investigate the relationship between the concentrations of NAA,Cr,Cho and Lac and Gesell score in the WMD group.Results On the 7th day and 14th day after birth,the concentration of NAA in the WMD group was lower than that in the non-WMD group(P<0.05),and the concentrations of Cr,Cho and Lac were higher than those in the non-WMD group(P<0.05).ROC curves indicated that the AUC of the combined diagnosis of premature infants with WMD using MRS metabolic indicators NAA,Cr,Cho,and Lac on the 7th day and 14th day after birth were 0.857 and 0.844,and the specificity was 93.00% and 93.00%,which were higher than those of diagnosis with single parameter(P<0.05).Following-up results of the WMD group at 12 months old showed 62(25.83%)premature infants with normal development,60(25.00%)with marginal development,and 118(49.17%)with development retardation.At 24 months old,there were 66(27.50%)premature infants with normal development,68(28.33%)with marginal development,and 106(44.17%)with development retardation.The concentrations of NAA,Cr,Cho,and Lac on the 7th day after birth showed significant differences among premature infants with different developmental levels in the WMD group at 12 and 24 months old(P<0.05).Compared with the normal development group,the concentration of NAA was lower,and the concentrations of Cr,Cho and Lac were higher in the development retardation group and the marginal development group(P<0.05).Compared with the marginal development group,the concentration of NAA was lower,and the concentrations of Cr,Cho and Lac were higher in the development retardation group(P<0.05).Pearson correlation analysis showed that Gesell scores of premature infants with WMD were positively correlated with the concentration of NAA,and negatively correlated with the concentrations of Cr,Cho and Lac(P<0.05).Conclusion MRS has high value in clinical diagnosis of WMD in premature infants.The concentrations of NAA,Cr,Cho and Lac measured by MRS are correlated with the development of premature infants with WMD,providing a basis for condition monitoring and prognosis evaluation of premature infants with WMD.
作者
洪菲
宋磊
魏燕
储晓彬
HONG Fei;SONG Lei;WEI Yan;CHU Xiaobin(Nantong First People’s Hospital,Nantong 226000,China)
出处
《中国实用神经疾病杂志》
2025年第9期1068-1073,共6页
Chinese Journal of Practical Nervous Diseases
基金
南通市民生科技计划项目(编号:MS22022026)。
关键词
脑白质损伤
磁共振波谱
早产儿
N-乙酰天门冬氨酸
肌酸
胆碱
乳酸
诊断价值
White matter damage
Magnetic resonance spectroscopy
Premature infant
N-acetyl-aspartate
Creatine
Choline
Lactic acid
Diagnostic value
