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目的探讨氢质子磁共振波谱(1H-MRS)对新生儿急性胆红素脑病(ABE)与缺氧缺血性脑病(HIE)的鉴别诊断价值。方法选取ABE患儿15例、HIE患儿16例,同时选取正常新生儿12人作为对照组,行头颅常规MRI及1H-MRS检查,对苍白球病变中心部位测定代谢产物N-乙酰天冬氨酸(NAA)、肌酸(Cr)、胆碱复合物(Cho)、乳酸(Lac)、谷氨酸及谷氨酰胺复合物(Glx)、肌醇(MI),计算NAA/Cr、Cho/Cr、Lac/Cr、Glx/Cr、MI/Cr比值,分析3组患儿脑内各代谢物浓度差异。结果 ABE组与HIE组的Lac/Cr分别为0.47±0.31和3.54±0.21,ABE组乳酸峰低平,HIE组乳酸峰明显升高,两组间差异有统计学意义(P<0.05);ABE组与HIE组的Glx/Cr均较对照组升高,且两组间差异有统计学意义;ABE组与HIE组的NAA/Cr较对照组降低,但两组间差异无统计学意义(P>0.05);Cho/Cr、MI/Cr在3组间均差异无统计学意义(P>0.05)。结论新生儿ABE和HIE均可表现为双侧苍白球T1WI高信号,1H-MRS可无创观察患儿病变区代谢情况,为其鉴别诊断提供重要信息。
Objective To investigate the diagnostic value of proton magnetic resonance spectroscopy (1H-MRS) in differential diagnosis of neonatal acute bilirubin encephalopathy (ABE) and hypoxic-ischemic encephalopathy (HIE). Methods Fifteen children with ABE and 16 children with HIE were enrolled. Twelve normal newborns were selected as the control group. The brain MRI and 1H-MRS were performed to determine the metabolites N-acetyl-aspartate NAA, Cho, Cho, Glx, Gln, NAA / Cr, Cho / Cr, Lac / Cr, Glx / Cr, MI / Cr ratio were calculated. Results The Lac / Cr ratios in ABE group and HIE group were 0.47 ± 0.31 and 3.54 ± 0.21, respectively. The lactic acid peak in ABE group was low and the lactic acid peak in HIE group was significantly increased. There was significant difference between the two groups (P <0.05) Glx / Cr in group and HIE group were higher than those in control group, and there was significant difference between two groups; NAA / Cr in ABE group and HIE group was lower than that in control group, but there was no significant difference between the two groups (P > 0.05). There was no significant difference in Cho / Cr, MI / Cr between the three groups (P> 0.05). Conclusions Both neonatal ABE and HIE can express high signal of T1WI in bilateral globus pallidus. 1H-MRS can be used for noninvasive observation of the metabolic status in children with lesions, providing important information for differential diagnosis.