摘要
目的探究磁共振检查(MRI)参数与缺血缺氧性脑病(HIE)新生儿脑损伤程度及远期神经预后的关系。方法选取2017年1月至2019年6月西安医学院第二附属医院收治的230例HIE新生儿为研究对象,根据是否发生预后不良分为预后不良组(n=47)和预后良好组(n=183)。比较不同脑损伤程度患儿的MRI参数,并采用受试者操作特征(ROC)曲线分析MRI参数对HIE患儿重度脑损伤的预测价值。采用多因素Logistic回归分析筛选HIE患儿远期神经预后不良的独立影响因素,构建列线图预测模型并进行评价。结果重度患儿T_(1)值、T_(2)值、DWI值明显高于轻度、中度患儿,中度患儿明显高于轻度患儿(P<0.05)。ROC曲线结果显示,T_(1)值、T_(2)值、DWI值联合预测重度脑损伤的AUC为0.875(95%CI:0.816~0.954),远大于各指标单独预测的AUC值。开始治疗时间、T_(1)值、T_(2)值、DWI值、HIE分度是HIE患儿预后不良的独立危险因素,而出生5min阿普加(Apgar)评分是其保护因素(P<0.05)。基于6项独立预测因素建立的列线图模型验证结果显示,ROC曲线下面积(AUC)为0.872(95%CI:0.798~0.923),Hosmer-Lemeshow拟合优度检验显示出较好的拟合度(P>0.05),提示模型区分度和准确度均较好。结论T_(1)值、T_(2)值、DWI值联合预测HIE患儿重度脑损伤的诊断价值远大于各指标单独预测价值。开始治疗时间、T_(1)值、T_(2)值、DWI值、HIE分度是HIE患儿预后不良的独立危险因素,而出生5 min Apgar评分是其保护因素(P<0.05)。
Objective To investigate the relationship between magnetic resonance imaging(MRI)parameters and the degree of brain injury and long-term neurological prognosis of neonates with hypoxic-ischemic encephalopathy(HIE).Methods A total of 230 HIE neonates admitted to the Second Affiliated Hospital of Xi’an Medical University from January 2017 to June 2019 were selected as the study subjects.According to the occurrence of poor prognosis,they were divided into poor prognosis group(n=47)and good prognosis group(n=183).MRI parameters of children with different degrees of brain injury were compared,and receiver operating characteristic(ROC)curve was used to analyze the predictive value of MRI parameters for severe brain injury in children with HIE.Multivariate Logistic regression analysis was used to screen the independent factors influencing the long-term poor neurological prognosis of HIE children,and the nomogram prediction model was constructed and evaluated.Results The values of T_(1),T_(2) and DWI in severe children were significantly higher than those in mild and moderate children,and those in moderate children were significantly higher than those in mild children(P<0.05).ROC curve results showed that T_(1),T_(2) and DWI combined to predict the AUC of severe brain injury was 0.875(95%CI:0.816-0.954),which was far higher than the AUC predicted by each index alone.The time to start treatment,T_(1) value,T_(2) value,DWI value and HIE score were independent risk factors for poor prognosis of HIE,while Apgar score 5 min after birth was a protective factor(P<0.05).The verification results of the nomogram model based on six independent predictors showed that the area under the ROC curve(AUC)was 0.872(95%CI:0.798-0.923),Hosmer-Lemeshow goodness of fit test showed a good fit(P>0.05),suggesting that the model had good differentiation and accuracy.Conclusion The diagnostic value of T_(1) value,T_(2)value and DWI value combined to predict severe brain injury in HIE children is far greater than the prediction value of each index alone.The time to start treatment,T_(1) value,T_(2) value,DWI value and HIE score were independent risk factors for poor prognosis of HIE,while Apgar score 5 min after birth was a protective factor(P<0.05).
作者
孟远翠
范金超
MENG Yuancui;FAN Jinchao(Department of Neonatology,the Second Affiliated Hospital of Xi’an Medical University,Xi’an,Shaanxi 710038,China)
出处
《中国优生与遗传杂志》
2023年第2期377-382,共6页
Chinese Journal of Birth Health & Heredity
关键词
磁共振检查
缺血缺氧性脑病
新生儿
预后
脑损伤
magnetic resonance imaging
hypoxic-ischemic encephalopathy
newborn
prognosis
brain damage
