磁共振形态学半定量评分对新生儿细菌性脑膜炎出院结局的评估价值

发布时间：2018-05-08 13:21

本文选题：新生儿 + 细菌性脑膜炎　；参考：《中国循证儿科杂志》2015年02期

【摘要】：目的分析MRI形态学半定量评分对新生儿细菌性脑膜炎出院结局的评估价值。方法收集复旦大学附属儿科医院2011年7月至2013年12月NICU收治的出院诊断为新生儿细菌性脑膜炎的病例,采用基于大脑损伤MRI形态学分析的半定量评分,对头颅MRI图像进行回顾性分析。MRI形态学评价包括脑室扩大、脑室旁白质容积丢失、脑白质囊性病灶、内囊后肢髓鞘化异常、皮质信号异常、颅内脑外间隙异常、基底节信号异常、脑白质非囊性信号异常、脑室内出血、脑室积脓、脑膜异常强化、室管膜异常强化和脑脓肿。将上述13项评分归纳为脑白质异常(WMA)、脑灰质异常(GMA)和非脑实质异常(NPA)。同时采集患儿出生孕周、发病时间、MRI检查时间、发病至MRI检查间隔时间和出院结局。按照出生孕周分为早产儿组和足月儿组,再按照出院结局分为预后良好和预后不良亚组,在各组内比较亚组之间时间因素、MRI单项评分和综合评分的差异。结果 63例新生儿细菌性脑膜炎病例进入分析(早产儿组18例,足月儿组45例)。MRI单项评分构成预后良好和预后不良亚组间差异有统计学意义的指标:早产儿组中有脑室扩大(P=0.012)和脑室旁白质容积丢失(P=0.004);足月儿组有脑室扩大(P=0.002)、脑室旁容积丢失(P=0.040)、颅内脑外间隙异常(P=0.005)和脑室内出血(P=0.038)。MRI综合评分中,早产儿组WMA评分(P=0.001)和NPA评分(P=0.039)、足月儿组NPA评分(P=0.018)在预后不良和预后良好亚组之间分布差异有统计学意义。足月儿组和早产儿组内不同预后亚组的各时间因素差异未发现统计学意义或临床意义。结论新生儿细菌性脑膜炎MRI脑室扩大和脑室旁白质容积丢失预示早产儿出院不良结局;脑室扩大、脑室旁白质容积丢失、颅内脑外间隙异常和脑室内出血预示足月儿出院不良结局。WMA评分高预示早产儿出院不良结局,NPA评分高预示早产儿和足月儿出院不良结局。
[Abstract]:Objective to analyze the value of MRI semi-quantitative score in evaluating the discharge outcome of neonatal bacterial meningitis. Methods patients with neonatal bacterial meningitis diagnosed by NICU from July 2011 to December 2013 in Pediatrics Hospital affiliated to Fudan University were collected. The semi-quantitative score based on MRI morphological analysis of brain injury was used. The morphological evaluation of cranial MRI included ventricular enlargement, volume loss of white matter, cystic lesion of white matter, abnormal myelinization of posterior limb of internal capsule, abnormal cortical signal and abnormal intracranial and extracranial space. Abnormal signal in basal ganglia, abnormal non-cystic signal in white matter, intraventricular hemorrhage, ventricular empyema, abnormal enhancement of meninges, abnormal enhancement of ependymal membrane and brain abscess. The above 13 scores were classified as white matter abnormality (WMA), gray matter abnormality (GMA) and noncerebral parenchymal abnormality (NPAA). At the same time, we collected the birth and gestational weeks, the time of onset, the interval between onset and MRI, and the outcome of discharge. According to the gestational weeks, the patients were divided into preterm infants and term infants, and then divided into good prognosis and poor prognosis subgroup according to the outcome of discharge. The difference of time factor and MRI single score and comprehensive score between subgroups were compared in each group. Results 63 cases of neonatal bacterial meningitis entered the analysis. In the term group, 45 cases had a good prognosis and a significant difference between the poor prognosis subgroups: there were ventricular dilatation in premature infants (P = 0.012) and volume loss of white matter in ventricular bypass (P 0.004); in term infants, ventricular dilatation (P = 0.002), and ventricular dilatation (P = 0.002). Paraventricular volume loss (PVV), abnormal intracranial space between brain and brain (P0. 005) and intraventricular hemorrhage (Mr). There were significant differences in the distribution of WMA score (0.001) and NPA score (P < 0.039) and NPA score (P < 0.018) between the two subgroups with poor prognosis and good prognosis. No statistical or clinical significance was found in the time factors of different prognostic subgroups in term infants and preterm infants. Conclusion the enlargement of MRI ventricle and the loss of volume of white matter in the ventricle of neonatal bacterial meningitis predict the adverse outcome of discharge of premature infants, and the volume loss of white matter in ventricle of premature infants, the enlargement of ventricle, and the loss of volume of white matter in ventricle of premature infants. Abnormal intracranial space and intracerebroventricular hemorrhage could predict the adverse discharge outcome of term infants. High WMA score could predict the adverse discharge outcome of premature infants and term infants, and NPA scores could predict the adverse discharge outcomes of preterm infants and term infants.
【作者单位】：复旦大学附属儿科医院放射科;复旦大学附属儿科医院新生儿科;
【分类号】：R722.1;R445.2

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