DTI技术测定新生儿病理性黄疸患儿小脑齿状核FA VR与病情的关系及预测ABE价值

doi:10.3969/j.issn.1006-6233.2021.03.027

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摘要目的分析磁共振弥散张量成像(DTI)技术测定新生儿病理性黄疸患儿小脑齿状核各向异性分数(FA)、容积再现(VR)与病情的关系及预测急性胆红素脑病(ABE)价值。方法选取2018年6月至2020年6月我院单纯新生儿病理性黄疸患儿85例作为黄疸组,并选取同期继发为ABE的新生儿病理性黄疸患儿73例,作为ABE组。均接受DTI技术检测,比较两组一般资料、病情程度、新生儿神经行为测定(NBNA)评分、实验室指标[总胆汁酸(TBA)、总胆红素(TSB)、直接胆红素(DBil)、丙氨酸氨基转移酶(ALT)、γ-谷氨酰转移酶(GGT)]水平、小脑齿状核FA、VR,分析小脑齿状核FA、VR与新生儿病理性黄疸病情程度、NBNA评分、实验室指标的相关性及与ABE发生的关系,并评价小脑齿状核FA、VR对ABE发生的预测价值。结果两组病情程度、NBNA评分比较,差异具有统计学意义(P<0.05);ABE组TSB、DBil、TBA、小脑齿状核VR高于黄疸组,小脑齿状核FA短于黄疸组(P<0.05);新生儿病理性黄疸患儿小脑齿状核FA与NBNA评分呈正相关,与病情程度、TSB、DBil、TBA呈负相关;小脑齿状核VA与NBNA评分呈负相关,与病情程度、TSB、DBil、TBA呈正相关(P<0.05);病情程度、NBNA评分、TSB、小脑齿状核FA、VR与ABE发生显著相关(P<0.05);小脑齿状核FA、VR联合预测ABE发生AUC最大,为0.810,敏感度、特异度分别为71.23%、78.82%。结论小脑齿状核FA、VR与新生儿病理性黄疸患儿病情程度存在显著相关性,早期采用DTI测定小脑齿状核FA、VR,可为临床评估病情程度、预测ABE发生提供有效辅助手段。

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关键词 ：磁共振弥散张量成像技术, 新生儿病理性黄疸, 小脑齿状核, 各向异性分数, 容积再现, 急性胆红素脑病

Abstract：Objective: To analyze the relation between the severity of the disease and magnetic resonance diffusion tensor imaging (DTI) technology in determining fractional anisotropy (FA) and volume reconstructio (VR) of the cerebellar dentate nucleus in children with neonatal pathological jaundice and to analyze the value of predicting the occurrence of acute bilirubin encephalopathy (ABE). Methods: A total of 85 children with simple neonatal pathological jaundice in our hospital from June 2018 to June 2020 were selected as the jaundice group,and 73 children with neonatal pathological jaundice secondary to ABE during the same period were selected as the ABE group. All have been tested by DTI technology. The general information,disease severity,neonatal behavioral neurological assessment (NBNA) score,laboratory indicators [total bile acid (TBA),total bilirubin (TSB),direct bilirubin (DBil),alanine aminotransferase (ALT),γ-glutamyltransferase (GGT)] levels,FA and VR in the cerebellar dentate nucleus were compared between the two groups. The relationship between FA and VR of cerebellar dentate nucleus and the severity of pathological jaundice,NBNA score,laboratory indicators and the occurrence of ABE were analyzed,and the predictive value of FA and VR of cerebellar dentate nucleus on the occurrence of ABE was evaluated. Results: There was a statistically significant difference in the degree of illness and NBNA score between the two groups (P<0.05). The TSB,DBil,TBA and VR of the cerebellar dentate nucleus in the ABE group were higher than those in the jaundice group,and the FA of the cerebellar dentate nucleus was shorter than that in the jaundice group (P<0.05). The FA of the cerebellar dentate nucleus in children with neonatal pathological jaundice was positively correlated with the NBNA score,and negatively correlated with the severity of the disease; TSB,DBil,and TBA. The VA of the cerebellar dentate nucleus was negatively correlated with the NBNA score,and positively correlated with the severity of the disease,TSB,DBil,and TBA (P<0.05). The severity of illness,NBNA score,TSB,cerebellar dentate nucleus FA,VR and ABE were significantly correlated (P<0.05). The combination of FA and VR in the cerebellar dentate nucleus predicted the highest AUC in ABE,which was 0.810,and the sensitivity and specificity were 71.23% and 78.82%,respectively. Conclusion: The FA and VR of the cerebellar dentate nucleus are significantly correlated with the severity of neonatal pathological jaundice. Early detection of FA and VR of the cerebellar dentate nucleus by DTI can provide effective auxiliary means for clinical evaluation of the severity of the disease and predicting the occurrence of ABE.

Key words： Magnetic resonance diffusion tensor imaging technique Neonatal pathological jaundice Cerebellar dentate nucleus Fractional anisotropy Volume reproduction Acute bilirubin encephalopathy

基金资助:重庆市基础与前沿研究计划项目,(编号:Y2016023222)

引用本文:

黄开平, 王荣芬, 刘云昇. DTI技术测定新生儿病理性黄疸患儿小脑齿状核FA VR与病情的关系及预测ABE价值[J]. 河北医学, 2021, 27(3): 480-486.
HUANG Kaiping, et al. The Relationship Between FA,VR of Cerebellar Dentate Nucleus and the Condition of Neonatal Pathological Jaundice by DTI Technique and Its Value in Predicting ABE. HeBei Med, 2021, 27(3): 480-486.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2021.03.027 或 http://www.hbyxzzs.cn/CN/Y2021/V27/I3/480

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