Phosphorus magnetic resonance spectroscopy 2 h after perinatal cerebral hypoxia-ischemia prognosticates outcome in the newborn piglet
Phosphorus magnetic resonance spectroscopy 2 h after perinatal cerebral hypoxia-ischemia prognosticates outcome in the newborn piglet
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DOI：
10.1111/j.1471-4159.2008.05662.x
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发表时间：
2008-11-01
影响因子：
4.7
通讯作者：
Robertson, Nicola J.
中科院分区：
文献类型：
--
作者：
Cady, Ernest B.;Iwata, Osuke;Robertson, Nicola J.
磷磁共振波谱（P-31 MRS）通常在分娩后缺氧缺血（HI）后的最初几个小时内显示明显正常的脑代谢，而此时常规的临床损伤严重程度评估是有问题的。我们的目标是阐明早期损伤严重程度的生物标志物。对27头新生仔猪进行脑HI: p -31- mrs测量，与HI后2小时相似，以6小时后观察到的最小三磷酸核苷酸（NTP）量化的二次能量衰竭严重程度定义的损伤组进行比较。与基线相比，重度和中度损伤的[Pi]/[总可交换高能磷酸池（EPP）]升高（p < 0.001和< 0.02），[NTP]/[EPP]降低（p < 0.03和< 0.006）。重度损伤[Pi]/[EPP]较轻度损伤升高（p < 0.04）。轻度损伤[磷酸肌酸]/[EPP]升高（p < 0.004）。严重损伤的细胞内pH值较基线呈碱性（p < 0.002）。重型和中度损伤[总Mg]/[ATP] （p < 0.0002和< 0.02）和[游离Mg] （p < 0.0001和< 0.02）均较基线升高。[Pi]/[EPP]、[磷酸肌酸]/[Pi]和[NTP]/[EPP]与损伤严重程度呈线性相关（p分别< 0.005、< 0.005和< 0.02）。[Pi]/[EPP]、细胞内pH值和细胞内Mg值升高（类似于产时HI后2小时）可能预示严重损伤，而[磷酸肌酸]/[EPP]升高可能提示轻度损伤。体内P-31 MRS可能有潜力提供新生儿脑病的早期预后。
Phosphorus magnetic resonance spectroscopy (P-31 MRS) often reveals apparently normal brain metabolism in the first hours after intrapartum hypoxia-ischemia (HI) at a time when conventional clinical assessment of injury severity is problematic. We aimed to elucidate very-early, injury-severity biomarkers. Twenty-seven newborn piglets underwent cerebral HI: P-31-MRS measures similar to 2 h after HI were compared between injury groups defined by secondary-energy-failure severity as quantified by the minimum nucleotide triphosphate (NTP) observed after 6 h. For severe and moderate injury versus baseline, [Pi]/[total exchangeable high-energy phosphate pool (EPP)] was increased (p < 0.001 and < 0.02, respectively), and [NTP]/[EPP] decreased (p < 0.03 and < 0.006, respectively): severe-injury [Pi]/[EPP] was also increased versus mild injury (p < 0.04). Mild-injury [phosphocreatine]/[EPP] was increased (p < 0.004). Severe-injury intracellular pH was alkaline versus baseline (p < 0.002). For severe and moderate injury [total Mg]/[ATP] (p < 0.0002 and < 0.02, respectively) and [free Mg] (p < 0.0001 and < 0.02, respectively) were increased versus baseline. [Pi]/[EPP], [phosphocreatine]/[Pi] and [NTP]/[EPP] correlated linearly with injury severity (p < 0.005, < 0.005 and < 0.02, respectively). Increased [Pi]/[EPP], intracellular pH and intracellular Mg similar to 2 h after intrapartum HI may prognosticate severe injury, whereas increased [phosphocreatine]/[EPP] may suggest mild damage. In vivo P-31 MRS may have potential to provide very-early prognosis in neonatal encephalopathy.