摘要
目的探讨表观弥散系数(ADC)对亚低温治疗缺氧缺血性脑病(HIE)新生儿的预后预测价值。方法选取2015年3月至2017年5月期间收治在马鞍山妇幼保健院新生儿科病房的HIE足月新生儿共51例,均采用选择性头部亚低温治疗,根据治疗后神经运动发育商评分分为预后良好组和预后不良组,利用磁共振扩散加权成像检测感兴趣区表观弥散系数值,分析两组患儿在出生后7d、14d、28d不同时间节点感兴趣区的ADC值,同时分析患者预后情况。利用ROC曲线分析ADC值对亚低温治疗HIE新生儿预后的价值。结果预后良好组的HIE患儿于出生后28d在额叶白质、顶叶白质、尾状核、丘脑、放射冠的ADC值明显高于预后不良组,存在统计学差异(t值分别为5.451、6.016、6.337、6.558、6.002,P值分别为0.032、0.021、0.018、0.016、0.023)。预后良好组的HIE患儿在出生后14d和28d的MDI和PDI评分均明显高于预后不良组,差异具有统计学意义(t值分别为6.532、6.768、7.104、7.325,P值分别为0.041、0.037;0.033、0.029)。ROC曲线分析结果显示HIE患儿出生后28d检测感兴趣区的ADC值对预后的预测价值灵敏度为0.832,特异度为0.904,AUC为0.811,95%CI:0.603~0.796。结论对采用头部亚低温治疗的HIE患儿,在出生后28d检测感兴趣的ADC值对预测患儿预后具有重要价值,值得在临床中推广应用。
Objective To discuss the prognostic value of apparent diffusion coefficient（ADC）in neonates with hypoxic-ischemic encephalopathy（HIE）treated with mild hypothermia.Methods Totally 51 full-term neonates with HIE who were admitted to the ward of department of neonatology in Ma＇anshan Municipal Health Hospital for Women and Children during March 2015 to May2017 were selected and were treated with selective brain mild hypothermia therapy.According to the scores of neuromotor development after treatment,the neonates were divided into favorable prognosis group and unfavorable prognosis group.The apparent diffusion coefficient（ADC）value of the region of interest was detected by diffusion-weighted imaging.The ADC values at different time points at 7 d,14 dand 28 dafter birth and the prognosis of neonates in two groups were analyzed.The values of ADC in the prognosis of HIE neonates treated with mild hypothermia were analyzed by using ROC curve.Results The ADC values of white matter in frontal lobe,white matter in parietal lobe,caudate nucleus,thalamus and corona radiata of HIE patients in favorable prognosis group were significantly higher than those in unfavorable prognosis group at 28 dafter birth（t value was 5.451,6.016,6.337,6.558 and 6.002,respectively,P value was 0.032,0.021,0.018,0.016 and 0.023）.At 14 dand 28 dafter birth,the MDI scores and PDI scores of HIE patients in favorable prognosis group were significantly higher than those in unfavorable prognosis group（t value was 6.532,6.768,7.104 and 7.325,respectively,Pvalue was 0.041,0.037,0.033 and 0.029）.The ROC curve analysis showed that in the prognostic value of the ADC for detecting the region of interest in neonates with HIE at 28 dafter birth,the sensitivity was 0.832,the specificity was 0.904,AUC was 0.811,and 95% CI ranged 0.603-0.796.Conclusion For the neonates with HIE treated with mild hypothermia therapy,the detection of the ADC value at 28 dafter birth is of great value in predicting the prognosis,which is worth to be spread in clinical practice.
出处
《中国妇幼健康研究》
2018年第2期153-156,共4页
Chinese Journal of Woman and Child Health Research
关键词
亚低温治疗
缺氧缺血性脑病
新生儿
表观弥散系数
预后
mild hypothermia therapy
hypoxic-ischemic encephalopathy （HIE）
neonate
apparent diffusion coefficient （AIX2）
prognosis
