新生儿缺氧缺血性脑病影像学诊断的比较研究

在围产新生儿医学所有问题中,新生儿脑损伤的治愈率和其生存后的生活质量,仍然是儿科医师的一个重要的研究课题。早期诊断和及时适宜地治疗脑损伤是改善预后的关键。为此,我们对住院的新生儿窒息病人常规进行头颅B超检查,并做CT对照,以求在边远基层地区获得最佳诊疗手段,及时施治有效的医疗措施,减轻脑损伤程度,提高新生儿存活率,降低神经系统后遗症的发生率。1对象与方法1.1对象1996年10月～2001年6月住院的新生儿窒息病人80例。入院日龄最小5m in,最大3d,平均(0.45熏2.04)h;80例中男47例,女33例;重度窒息56例,轻度窒息24例;早产儿2例,足…     

The value of a scoring system for hypoxic ischaemic encephalopathy in predicting neurodevelopmental outcome

Abstract A numeric scoring system for the assessment of hypoxic ischaemic encephalopathy during the neonatal period was tested. The value of the score in predicting neurodevelopmental outcome at 1 y of age was assessed. Forty-five infants who developed hypoxic ischaemic encephalopathy after birth were studied prospectively. In addition to the hypoxic ischaemic encephalopathy score all but two infants had at least one cranial ultrasound examination. Thirty-five infants were evaluated at 12 months of age by full neurological examination and the Griffiths Scales of Mental Development. Five infants were assessed at an earlier stage, four who died before 6 months of age and one infant who was hospitalized at the time of the 12 month assessment. Twenty-three (58%) of the infants were normal and 17 (42%) were abnormal, 16 with cerebral palsy and one with developmental delay. The hypoxic ischaemic encephalopathy score was highly predictive for outcome. The best correlation with outcome was the peak score; a peak score of 15 or higher had a positive predictive value of 92% and a negative predictive value of 82% for abnormal outcome, with a sensitivity and specificity of 71% and 96%, respectively. For the clinician working in areas where sophisticated technology is unavailable this scoring system will be useful for assessment of infants with hypoxic ischaemic encephalopathy and for prognosis of neurodevelopmental outcome.     

Epidemiology of neonatal encephalopathy and hypoxic-ischaemic encephalopathy

Neonatal encephalopathy (NE) is the clinical manifestation of disordered neonatal brain function. Lack of universal agreed definitions of NE and the sub-group with hypoxic-ischaemia (HIE) makes the estimation of incidence and the identification of risk factors problematic. NE incidence is estimated as 3.0 per 1000 live births (95%CI 2.7 to 3.3) and for HIE is 1.5 (95%CI 1.3 to 1.7). The risk factors for NE vary between developed and developing countries with growth restriction the strongest in the former and twin pregnancy in the latter. Potentially modifiable risk factors include maternal thyroid disease, receipt of antenatal care, infection and aspects of the management of labour and delivery, although indications for some interventions were not reported and may represent a response to fetal compromise rather than the cause. It is estimated that 30% of cases of NE in developed populations and 60% in developing populations have some evidence of intrapartum hypoxic-ischaemia.     

新生儿缺氧缺血性脑病血清神经元特异性烯醇化酶和头颅CT的变化

目的探讨血清神经元特异性烯醇化酶（ＮＳＥ）和头颅ＣＴ在新生儿缺氧缺血性脑病（ＨＩＥ）诊断中的作用。方法ＨＩＲ患儿２０例，用酶联免疫法测定生后８天、７天血清ＮＳＥ浓度。生后１周内行头颅ＣＴ检查。结果ＨＩＥ患儿血清ＮＳＥ在生后３天均升高，尤以中、重度明显，与临床分度一致。重度ＨＩＥ患儿头颅ＣＴ分度与临床一致，轻、中度头颅ＣＴ分度与临床不平行。结论血清ＮＳＥ测定是早期诊断ＨＩＥ及判断脑损伤的有效指标，头颅ＣＴ检查结合血清ＮＳＥ测定可更为准确地帮助ＨＩＥ的诊断和治疗。     

新生儿缺氧缺血性脑病与T辅助细胞亚群功能失衡研究

目的研究缺氧缺血性脑病（HIE）新生儿T辅助细胞（Th）亚群功能失衡的特点，探讨，Th1和Th2类细胞因子与HIE严重程度之间的关系。方法酶联免疫吸附试验方法，对35例HIE患儿和15例健康对照者外周血单个核细胞（PBMO）经植物血凝素（PHA）刺激后，对培养上清液中Th1和Th2类细胞因子含量进行测定。结果经（PHA）刺激后，HIE组，Th1产生IFN-γ、IL-2水平（中位数）明显低于正常对照组（IFN-γ：106pg／ml比427pg／ml，P〈0．01。IL-2：527pg／ml比1218pg／ml，P〈0．01），而Th2产生IL-4、IL-6水平（中位数）则明显高于正常对照组（IL-4：248pg／ml vs．112pg／ml，P〈0．05。IL-6：643pg／mlVS．86pg／ml，P〈0．01）。相关分析发现：IL-6水平与HIE严重程度呈显著正相关，r=0．474，P〈0．01；IL-2、IFN-γ水平与HIE严重程度呈负相关，r分别为-0．352和-0．357，P值均〈0．05；IL-4水平与HIE严重程度无相关性，r=0．277，P〉0．05。结论HIE新生儿Th1类细胞因子水平明显降低，Th2类细胞因子水平明显增高，导致T辅助细胞亚群功能失衡，此在HIE的发病机制中起重要作用。Th类细胞因子水平与HIE严重程度相关。     

新生儿缺氧缺血性脑病与T辅助细胞亚群功能失衡研究

目的研究缺氧缺血性脑病(HIE)新生儿T辅助细胞(Th)亚群功能失衡的特点,探讨Th_1和Th_2类细胞因子与HIE严重程度之间的关系。方法酶联免疫吸附试验方法,对35例HIE患儿和15例健康对照者外周血单个核细胞(PBMO)经植物血凝素(PHA)刺激后,对培养上清液中Th_1和Th_2类细胞因子含量进行测定。结果经(PHA)刺激后,HIE组Th_1产生IFN-γ、IL-2水平(中位数)明显低于正常对照组(IFN-γ：106 pg／ml比427 pg／ml,P＜0.01。IL-2：527 pg／ml比1218 pg／ml,P＜0.01),而Th_2产生IL-4、IL-6水平(中位数)则明显高于正常对照组(IL-4：248 pg/ml vs．112 pg／ml,P＜0.05。IL-6：643 pg／ml vs．86 pg／ml,P＜0.01)。相关分析发现：IL-6水平与HIE严重程度呈显著正相关,r=0.474,P＜0.01；IL-2、IFN-γ水平与HIE严重程度呈负相关,r分别为-0.352和-0.357,P值均＜0.05；IL-4水平与HIE严重程度无相关性,r=0.277,P＞0.05。结论HIE新生儿Th_1类细胞因子水平明显降低,Th_2类细胞因子水平明显增高,导致T辅助细胞亚群功能失衡,此在HIE的发病机制中起重要作用。Th类细胞因子水平与HIE严重程度相关。     

Hypertensive encephalopathy in a patient with neonatal thyrotoxicosis

Neonatal hyperthyroidism may give rise to serious cardiovascular complications. A girl with severe thyrotoxicosis in whom hypertensive encephalopathy developed is described. Conclusion Neonatal thyrotoxicosis can give rise to hypertension and may lead to hypertensive encephalopathy. Received: 9 January 1998 / Accepted: 4 March 1999     

铁代谢与新生儿缺氧缺血性脑病

铁稳态的维持对机体至关重要,铁承担着氧运输和电子传递,并参与神经递质和髓鞘的合成.近年来大量的研究发现铁在局部沉积将对机体产生毒害作用,特别是铁过剩现象出现在中枢神经系统的组织和细胞,甚至是神经细胞的细胞器内,将导致中枢神经系统发生不可逆转的病理性改变.该文综述了脑缺氧缺血后脑中铁及循环铁的变化,并讨论了铁代谢与新生儿缺氧缺血性脑病发病机制方面的研究进展.     

The hypoxic ischaemic encephalopathy score in predicting neurodevelopmental outcomes among infants with birth asphyxia at the Muhimbili National Hospital, Dar-es-Salaam, Tanzania

Hypoxic Ischemic Encephalopathy (HIE) score may be used to predictneurodevelopment outcome in infants with birth asphyxia. A totalof 140 infants who had a 5 min Apgar score of <7 at birthhad detailed motor and neurodevelopment assessment. Outcomemeasures were grouped as normal or abnormal with morbidity (convulsions,abnormal muscle tone and delayed development) or death. Thepositive predictive value (PPV) for mortality was 42.3% formoderate HIE and 93.8% for severe HIE. For severe HIE the PPVwas 100%. Thirteen infants had delayed development, the scorehad PPV of 63.6% for moderate HIE and 100% for severe HIE. Thebest correlation with outcome was the peak score of 15 or higherhad a PPV of 100%. Specificity was found to be 100% and sensitivityof 14%. The HIE scoring system is a useful predictor of neurodevelopmentoutcome at 6 months of age in a resource poor setting.     

新生儿缺氧缺血性脑病的MRI研究进展

新生儿缺氧缺血性脑病(hypoxia ischemic encephalopathy,HIE)是指由围生期缺氧窒息导致的脑缺氧缺血性损伤.随着MRI技术的不断发展,MRI不仅能反映新生儿HIE的解剖、病理改变,而且能够反映其早期分子水平和代谢水平的变化,进行HIE病变性质与程度评价,并且无放射性损害,是HIE理想的影像检查方法.该文就近年来MRI在HIE诊断、判断预后等方面应用的研究进展作一综述.     

严重高胆红素血症新生儿急性胆红素脑病危险因素分析

目的 探讨严重高胆红素血症新生儿急性胆红素脑病（ABE）发生的危险因素。方法选择本院2010年1月至2012年12月诊治的胎龄≥35周、血清胆红素（TSB）峰值〉425μmol/L且资料完整、进行了头颅核磁共振及脑干听觉诱发电位检查的患儿,根据是否符合ABE的诊断标准分为病例组和对照组,对一般资料、母孕期情况、合并症、围生期缺氧、黄疸的发生发展过程及实验室指标共22项临床因素进行单因素分析,对其中13项进行多因素Logistic回归分析。结果病例组43例,对照组30例,单因素分析显示,病例组出生后体重下降程度、TSB峰值、平均每日胆红素上升值及B/A值均高于对照组,差异有统计学意义（P〈0.05）;多因素分析提示,严重黄疸诊断日龄、围生期缺氧史及酸中毒与ABE的发生相关,OR（95%可信区间）分别为0.545（0.413~0.962）、36.589（1.114~1202.032）、7.963（1.294~49.010）,P均〈0.05。结论 在严重高胆红素血症新生儿中,严重黄疸诊断日龄越小,曾有围生期缺氧史和（或）伴有酸中毒者,ABE发生风险越高;而母乳喂养、出生后体重下降多、存在母子血型不合溶血、葡萄糖-6-磷酸脱氢酶缺陷则可能是严重高胆红素血症的原因。加强黄疸的监测、对严重高胆红素血症患儿积极纠正酸中毒,可能有助于预防胆红素脑病。     

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??Hypoxic ischemic encephalopathy??HIE?? is the most important reason for morbidity and mortality in term-born infants. Neonatal HIE is seen approximately in 2-3/1000 live births. Moreover?? in the developing countries?? its frequency has risen up to 26/1000 live births. Among the remaining living newborns?? cerebral palsy?? epilepsy?? autism?? visual and auditory problems are diagnosed. Therapeutic hypothermia is now well-established as standard treatment for infants with moderate to severe hypoxic-ischemic encephalopathy. In this review?? the clinical appilication of therapeutic hypothermia in neonatal hypoxic-ischemic encephalopathy will be discussed.     

新生儿缺氧缺血性脑病第二次多中心治疗总结

目的　进一步证实“新生儿缺氧缺血性脑病 (HIE)治疗方案 (试行稿 )”的疗效。方法　统计国内 5 4所医院 114 5份HIE病例的临床资料 ,所有病例均按上述治疗方案至少治疗 1个疗程 ,并随访至少 6个月。结果　HIE患儿总的预后不良率为 5 15 % ,其中重度预后不良率为 2 0 8% ,中度为 2 2 2 % ,轻度为 0 ,与第 1次多中心治疗比较 ,预后不良率略有下降。结论　上述治疗方案的疗效是肯定的 ,经得起大样本的重复试验 ,新生儿期后治疗可明显改善重度HIE的预后。     

Managing hypoxic ischaemic encephalopathy in term newborn infant

Hypoxic–ischaemic encephalopathy (HIE) is a brain dysfunction resulting from inadequate blood flow and oxygenation to the whole body during the perinatal period. It is a major cause of brain injury and is associated with mortality and significant disabilities in later life. Following HIE acute, secondary and tertiary phases of brain injury lasting from hours to years occurs. Therapeutic hypothermia reduces death and improves the neurodevelopment in infants with moderate to severe HIE. Passive cooling can be initiated soon after birth in infants that fulfil criteria for the treatment. Active cooling with appropriate intensive and supportive care including respiratory and cardiovascular support, maintaining normoglycaemia, sedation, and seizure management is essential for minimising the brain injury. In cooled infants likely to have a worse prognosis re-orientation of care is often considered in the infant's best interests. This short review aims to explain the underlying pathophysiological effects of HIE and its management.