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目的评价彩色多普勒超声对新生儿缺氧缺血性脑病(HIE)定性诊断及定量分析的价值。方法对确诊为HIE的足月新生儿90例(轻度HIE 50例,中重度HIE 40例)和正常足月新生儿48例进行颅脑彩色多普勒超声检查,观察脑室旁白质回声改变,并对其灰度值行定量分析;应用脉冲多普勒测量双侧大脑中动脉(MCA)的收缩期峰值流速(Vs)、舒张期末流速(Vd)、阻力指数(RI)。结果 (1)对照组、轻度组、中重度组比较,脑室旁白质定量灰度值差异均有统计学意义(P<0.05)。(2)应用ROC曲线评价脑室旁白质灰度值对脑白质是否有损伤的预测能力:曲线下面积0.926,灵敏度0.811%、特异度0.917%、截断值为74.6;应用ROC曲线评价脑室旁白质灰度值对HIE损伤程度的预测能力:曲线下面积0.915,灵敏度0.95%、特异度0.74%、截断值为79.7。(3)左、右侧MCA的Vs、Vd、RI三组间差异均有统计学意义(P<0.05)。结论头颅超声可早期诊断HIE,脑室旁白质定量灰度值及MCA频谱分析能够为临床分度提供依据。
Objective To evaluate the value of color Doppler ultrasound in qualitative diagnosis and quantitative analysis of neonatal hypoxic-ischemic encephalopathy (HIE). Methods 90 cases of full-term newborns diagnosed as HIE (mild HIE 50 cases, 40 cases of moderate and severe HIE) and 48 cases of normal term newborns were examined by color Doppler echocardiography to observe the changes of left ventricular white matter echo, The gray value of the middle cerebral artery (MCA) was measured by pulse Doppler. The peak systolic velocity (Vs), end-diastolic velocity (Vd) and resistance index (RI) were measured. Results (1) Compared with control group, mild group and moderate-severe group, there were significant differences in quantitative gray value of ventricular white matter (P <0.05). (2) The ROC curve was used to evaluate the predictive ability of gray matter of ventricular white matter on the white matter damage: the area under the curve was 0.926, the sensitivity was 0.811%, the specificity was 0.917% and the cutoff was 74.6; Degree of HIE damage prediction ability: the area under the curve 0.915, sensitivity of 0.95%, specificity of 0.74%, cut-off value of 79.7. (3) The differences of Vs, Vd and RI between the left and right MCA were statistically significant (P <0.05). Conclusion The early diagnosis of HIE by cranial ultrasound, quantitative gray value of ventricular white matter and MCA spectrum analysis can provide the basis for clinical indexing.