摘要
目的：通过氢质子磁共振波谱（1 H magnetic resonance spectroscopy,1 H MRS）检测小于胎龄儿（ small for gestational age,SGA）及适于胎龄儿（ appropriate for gestational age,AGA）的脑代谢物,应用MRI加软件测量患儿脑内不同部位的体积,探讨其脑代谢物和脑内不同部位体积的变化和意义。方法选取符合条件者88例,早产儿SGA组27例,早产儿AGA组21例；足月儿SGA组22例,足月儿AGA组18例；早产儿胎龄32-36周,足月儿胎龄37-41周。检查时日龄4-7 d。计算大脑体积、小脑体积、脑脊液体积和颅内腔体积,1 H MRS测量右侧额叶的代谢物N-乙酰天门冬氨酸（ N-acetylaspartic acid,NAA）、胆碱复合物（choline compounds,Cho）和肌酸复合物（creatine compounds,Cr）波峰下面积,计算NAA/Cr、Cho/Cr和NAA/Cho比值。结果 NAA/Cr、大脑体积及颅内腔体积依次分别为：早产儿SGA组和AGA组[NAA/Cr：0．627±0．183 vs．0．734±0．101；大脑体积：（2．831±0．199）× 10^5 mm^3 vs．（2．987±0．111）× 10^5 mm^3；颅内腔体积：（3．178±0．209）× 10^5 mm^3 vs．（3．347±0．137）× 10^5 mm^3],足月儿SGA组和AGA组：[ NAA/Cr：0．706±0．139 vs．0．805±0．106；大脑体积：（3．056±0．217）× 10^5 mm^3 vs．（3．228±0．284）× 10^5 mm^3；颅内腔体积：（3．411±0．212× 10^5 mm^3 vs．（3．588±0．306）× 10^5 mm^3],早产儿、足月儿SGA和AGA混合组：[ NAA/Cr：0．708±0．171 vs．0．721±0．119；大脑体积：（2．932±0．234）× 10^5 mm^3 vs．（3．098±0．240）× 10^5 mm^3；颅内腔体积：（3．282±0．239）× 10^5 mm^3 vs．（3．458±0．258）× 10^5 mm^3,P均〈0．05],SGA组均小于相应AGA组,差异均有统计学意义（P均〈0．05）,早产儿SGA组均小于相应足月儿SGA组,差异均有统计学意义（P均〈0．01）。 Cho/Cr、小脑体积及脑脊液体积依次分别为：早产儿SGA组和AGA组[ Cho/Cr：1．653±0．343 vs．1．531±0．226；小脑体积：（1．816±0．119）× 10^4 mm^3 vs．（1．872±0．159）× 10^4 mm^3；脑脊液体积：（1．651±0．235）×104mm3vs．（1．731±0．280）×104mm3],足月儿SGA组和AGA组：[Cho/Cr：1．588±0．223vs．1．528±0．107；小脑体积：（1．936±0．957）× 10^4 mm^3 vs．（2．017±0．302）× 10^4 mm^3；脑脊液体积：（1．623±0．210）× 10^4 mm^3 vs．（1．648±0．169）× 10^4 mm^3],早产儿、足月儿 SGA 和 AGA 混合组：[Cho/Cr：1．612±0．262 vs．1．583±0．222；小脑体积：（1．870±0．124）× 10^4 mm^3 vs．（1．939±0．244）× 10^4 mm^3；脑脊液体积：（1．649±0．206）× 10^4 mm^3 vs．（1．681±0．252）× 10^4 mm^3],SGA组与相应AGA组比较差异均无统计学意义（ P均〉0．05）。 NAA/Cho早产儿SGA组小于AGA组（0．401±0．737 vs．0．506±0．116,P=0．000）,足月儿SGA组与AGA组比较差异无统计学意义（0．483±0．605 vs．0．472±0．987, P=0．653）。 NAA/Cr、NAA/Cho、小脑体积及脑脊液体积在早产儿AGA组与足月儿AGA组相比差异均无统计学意义（P均〉0．05）,大脑体积及颅内腔体积在早产儿AGA组与足月儿AGA组比较差异均有统计学意义（ P 均＜0．05）。结论 SGA 脑内神经元 NAA/Cr、大脑体积及颅内腔体积明显低于AGA,Cho/Cr、小脑体积及脑脊液体积SGA 与AGA无明显差别。 SGA脑内神经元NAA/Cr低及大脑体积小是否与其神经智力发育落后有关,值得深入研究。
Objective By 1 H magnetic resonance spectroscopy（ 1 H MRS） ,small for gestational age＆amp;nbsp;（SGA）and appropriate for gestational age（AGA） as the detection of brain metabolites and MRI plus software measurement in different brain areas of volume,investigate its cerebral metabolites and the changes of brain in different parts of the volume and significance. Methods Select 88 patients eligible infants, SGA group of 27 cases and AGA group of 21 cases of premature infants;SGA group of 22 cases and AGA group of 18 cases of term infants. Preterm infants with a gestational age of 32 to 36 weeks,term infants with a gestational age of 37 to 41 weeks. Check time between 4 to 7 days old. Calculation of cerebrum volume,cerebellar volume and cerebrospinal fluid volume and intracranial volume,N-acetylaspartic acid（NAA）,as 1H MRS area of metabolites measured right frontal choline compounds（ Cho） and creatine compounds（ Cr） wave,calculation of Cho/Cr and NAA/Cho ratio of NAA/Cr. Results NAA/Cr,the cerebrum volume and intracranial volume of SGA in premature infants group,term infants group and mixed group were 0. 627 ± 0. 183,（2. 831 ±0. 199） × 10^5 mm^3（3. 178 ±0. 209） × 10^5 mm^30. 706 ±0. 139,（3. 056 ±0. 217） × 10^5 mm^3（3. 411 ± 0. 212 × 10^5 mm^30. 708 ± 0. 171,（2. 932 ± 0. 234） × 105 mm3,（3. 282 ± 0. 239） × 105 mm3,respective-ly. NAA/Cr,the cerebrum volume and intracranial volume of AGA in premature infants group,term infants group and mixed group were 0. 734 ± 0. 101,（2. 987 ± 0. 111） × 105 mm3,（3. 347 ± 0. 137） × 105 mm3;0. 805 ± 0. 106, （ 3. 228 ± 0. 284 ） × 105 mm3 , （ 3. 588 ± 0. 306 ） × 105 mm3; 0. 721 ± 0. 119, （ 3. 098 ± 0.240） × 10^5 mm^3（3.458 ±0.258） × 10^5 mm^3respectively. The data of SGA group were all lower than those in AGA group,which had significant difference（P〈0. 05,respectively）. In SGA group,NAA/Cr,the cerebrum volume and intracranial volume of premature infants group were all lower than those in term infants group,which had significant difference（P〈0. 001,respectively）. In SGA group,Cho/Cr,cerebellar volume and cerebrospinal fluid volume of premature infants group,term infants group and mixed group were[1. 653 ± 0. 343,（1. 816 ± 0. 119） × 10^4 mm^3,（1. 651 ± 0. 235） × 10^4 mm^31. 588 ± 0. 223,（1. 936 ± 0. 957） × 10^4 mm^3（1. 623 ± 0. 210） × 10^4 mm^3 1. 612 ± 0. 262,（1. 870 ± 0. 124） × 10^4 mm^3（1. 649 ± 0. 206） × 10^4 mm^3,respectively. In AGA group, Cho/Cr, cerebellar volume and cerebrospinal fluid volume of premature infants group,term infants group and mixed group were 1. 531 ± 0. 226,（1. 872 ± 0. 159） × 10^4 mm^3,（1. 731 ±0.280） ×104 mm3;1.528 ±0.107,（2.017 ±0.302） ×104 mm3,（1.648 ±0.169） ×104 mm3;1.583 ± 0.222,（1.939±0.244）×104mm3,（1.681±0.252）×104mm3,respectively.ThedataofSGAgrouphad no significant difference with corresponding AGA group（P 〉0. 05,respectively）. In the premature infants groups,the NAA/Cho of SGA group（0. 401 ± 0. 737） was lower than in the AGA group（0. 506 ± 0. 116）, which had significant difference（P=0. 000）. In the term infants groups,the NAA/Cho of SGA group（0. 483 ±0. 605） was lower than in the AGA group（0. 472 ± 0. 987）,which had no significant difference（P =0. 653）. In the AGA groups,NAA/Cr,NAA/Cho,cerebellar volume and cerebrospinal fluid volume of pre-mature infants group and term infants group had no significant difference （ P〉0. 05 ） . Both of the cerebellar volume and cerebrospinal fluid volume between the premature infants AGA group and premature infants AGA group had no significant difference（P〉0. 05）. Conclusion Neurons in the brain,the cerebrum volume,the cranial cavity volume and NAA/Cr of SGA was significantly lower than those of AGA,but Cho/Cr,cerebellar volume and cerebrospinal fluid volume of SGA and AGA had no significant difference. NAA/Cr in the brain and the cerebrum volume of SGA may be associated with low volume of small nerve mental retardation,worthy of further study.
出处
《中国小儿急救医学》
CAS
2015年第4期241-244,248,共5页
Chinese Pediatric Emergency Medicine
基金
深圳市科技计划项目（201103304）
关键词
氢质子磁共振波谱
磁共振成像
脑代谢物
脑体积
小于胎龄儿
适于胎龄儿
Hydrogen proton magnetic resonance spectroscopy
Magnetic resonance imaging
Brain metabolites
Brain volume
Small for gestational age
Appropriate for gestational age
作者简介
通信作者：肖钢明，E-mail：xiaogangming929@163.com
