CEREBRAL LACTATE AND N-ACETYL-ASPARTATE/CHOLINE RATIOS IN ASPHYXIATED FULL-TERM NEONATES DEMONSTRATED IN-VIVO USING PROTON MAGNETIC-RESONANCE SPECTROSCOPY
CEREBRAL LACTATE AND N-ACETYL-ASPARTATE/CHOLINE RATIOS IN ASPHYXIATED FULL-TERM NEONATES DEMONSTRATED IN-VIVO USING PROTON MAGNETIC-RESONANCE SPECTROSCOPY
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DOI：
10.1203/00006450-199402000-00004
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发表时间：
1994-02-01
影响因子：
3.6
通讯作者：
DEVRIES, LS
中科院分区：
文献类型：
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作者：
GROENENDAAL, F;VEENHOVEN, R;DEVRIES, LS
本研究的目的是检验以下假设：窒息后脑病新生儿的高乳酸信号和低 N-乙酰天冬氨酸/胆碱比率表明使用质子磁共振波谱法时体内不良结果的可能性很高。对 21 名足月窒息新生儿进行了检查：平均出生后年龄为 7.1 天。五名患者死亡，五名幸存者患有残疾。 16 名幸存者中的 11 名（七名无残疾，四名有残疾）在 3 个月大时接受了第二次检查。磁共振成像后，在 15 特斯拉下获得光谱。通过基底神经节选择20毫米厚的切片。优化 B-0 场后，我们使用双自旋回波脉冲序列 (90-180-1800)，重复时间为 2000 毫秒，回波时间为 272 毫秒。二维光谱成像是通过 225 毫米视场中两个方向的 32 x 32 相位编码步骤进行的，产生 1 毫升体积，然后进行计算机处理。在第 6 周、第 3 个月以及此后每 3 个月检查一次神经运动发育。仅在 5 名 3 级窒息后脑病患者中观察到乳酸共振。乳酸分布广泛（n = 4），或局限于梗塞区域（n = 1）。发生不良后果的患者的 N-乙酰基-天冬氨酸/胆碱比率显着低于无残疾的幸存者，无论是新生儿期（p < 0.005，Wilcoxon 秩和检验）还是 3 个月时（p < 0.05）。总之，使用质子磁共振波谱在患有窒息后脑病的足月新生儿体内证明存在脑乳酸和低 N-乙酰基天冬氨酸/胆碱比，表明预后不良。
The purpose of this study was to test the hypothesis that a high lactate signal and a low N-acetyl-aspartate/choline ratio in neonates with postasphyxial encephalopathy indicated a high chance of an adverse outcome in vivo when proton magnetic resonance spectroscopy was used. Twenty-one full-term asphyxiated neonates were examined:at a mean postnatal age of 7.1 d. Five patients died, and five survivors had handicaps. Eleven of the 16 survivors (seven without handicaps and four with handicaps) had a second examination at 3 mo of age. After magnetic resonance imaging, spectra were obtained at 15 tesla. A 20-mm-thick slice was selected through the basal ganglia. After optimizing the B-0 field, we used a double spin-echo pulse sequence (90-180-1800) with a time to repeat of 2000 ms and a time to echo of 272 ms. Two-dimensional spectroscopic imaging was performed by 32 x 32 phase encoding steps in two directions in a 225-mm field of view, resulting in 1-mL volumes, followed by computerized processing. Neuromotor development was examined at 6 wk, 3 mo, and every 3 mo thereafter. Lactate resonances were seen only in the five patients with grade 3 postasphyxial encephalopathy. Lactate was distributed diffusely (n = 4), or localized in areas of infarction (n = 1). N-acetyl-aspartate/choline ratios were significantly lower in the patients dth an adverse outcome than in the survivors without handicaps, both neonatally (p < 0.005, Wilcoxon's rank sum test) and at 3 mo (p < 0.05). In conclusion, the presence of cerebral lactate and a low N-acetyl-aspartate/choline ratio demonstrated in vivo using proton magnetic resonance spectroscopy in full-term neonates with postasphyxial encephalopathy indicate a poor outcome.