Changes in Brain Metabolite Concentrations after Neonatal Hypoxic-ischemic Encephalopathy
Changes in Brain Metabolite Concentrations after Neonatal Hypoxic-ischemic Encephalopathy
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DOI：
10.1148/radiol.2018172083
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发表时间：
2018-09-01
期刊：
影响因子：
19.7
通讯作者：
Toyoshima, Katsuaki
中科院分区：
文献类型：
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作者：
Shibasaki, Jun;Aida, Noriko;Toyoshima, Katsuaki
目的：探讨新生儿缺氧缺血性脑病（HIE）时脑代谢物浓度的变化及其预测价值。材料与方法：68名新生儿（年龄、在2009年9月至2016年3月期间，新生儿重症监护室收治了35-41孕周的HIE患者，并在18-96小时（n = 25）和7- 10小时（n = 25）使用质子MR波谱进行检查。出生后14天（月经后35-43周）（n = 64），以估计深部灰质中的代谢物浓度。不良结局定义为18-22月龄时死亡或神经发育障碍。受试者工作特征曲线下的面积进行计算，以评估代谢物的预后值。结果：在18-96小时，N-乙酰天冬氨酸和肌酸浓度较低，而乳酸，谷氨酸和谷氨酰胺（Glx）浓度较高，在新生儿的不良后果比那些有利的结果。在第7-14天，不良结局的新生儿在18-96小时的代谢物浓度降低，但在良好结局的新生儿中没有变化。在18- 96小时测量N-乙酰天冬氨酸、肌酸、乳酸和Glx浓度以预测不良结局，受试者工作特征曲线下面积分别为0.98、0.89、0.96和0.88，而在7-14天，受试者工作特征曲线下面积分别为0.97、0.97、0.59和0.36，respectively.Conclusion:在18- 96小时和7-14天，N-乙酰天冬氨酸和肌酸浓度的时间依赖性降低准确预测不良结局。然而，较高的乳酸盐和谷氨酸盐和谷氨酰胺浓度往往是短暂的。(C)RSNA，2018
Purpose: To investigate the time-course changes and predictive utility of brain metabolite concentrations in neonatal hypoxicischemic encephalopathy (HIE).Materials and Methods: Sixty-eight neonates (age, 35-41 gestational weeks) with HIE were admitted to a neonatal intensive care unit between September 2009 and March 2016 and examined by using proton MR spectroscopy at 18-96 hours (n = 25) and 7-14 days (n = 64) after birth (35-43 postmenstrual weeks) to estimate metabolite concentrations in the deep gray matter. Adverse outcome was defined as death or neurodevelopmental impairment at 18-22 months of age. Areas under the receiver operating characteristic curves were calculated to evaluate the prognostic values of metabolites.Results: At 18-96 hours, N-acetylaspartate and creatine concentrations were lower, whereas lactate, and glutamate and glutamine (Glx) concentrations were higher in neonates with adverse outcomes than in those with favorable outcomes. Metabolite concentrations at 18-96 hours decreased during days 7-14 in neonates with adverse outcomes but did not change in those with favorable outcomes. For N-acetylaspartate, creatine, lactate, and Glx concentrations measured at 18- 96 hours to predict adverse outcomes, areas under the receiver operating characteristic curve were 0.98, 0.89, 0.96, and 0.88, respectively, whereas at 7-14 days, the areas under the receiver operating characteristic curve were 0.97, 0.97, 0.59, and 0.36, respectively.Conclusion: Time-dependent reductions in N-acetylaspartate and creatine concentrations at both 18- 96 hours and 7-14 days accurately predicted adverse outcomes. However, higher lactate and glutamate and glutamine concentrations were often transient. (C) RSNA, 2018