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1.
目的运用单体素氢质子波谱技术(1H-MRS)观察新生儿脑白质弥漫性高信号(DEHSI)成像特点,探讨DEHSI的演变规律及诊断价值。材料与方法对95名新生儿运用点分辨波谱序列对其脑组织兴趣区所得代谢数据进行分析研究。结果生后年龄、胎龄、头围均与DEHSI评估之间呈显著负相关(r=-0.398、r=-0.390、r=-0.269,P值均0.05)。胎龄、生后年龄与NAA/Cr(r=0.386、r=0.328,P值均0.05),NAA/Cho(r=0.432、r=0.367,P值均0.05)呈正相关,与Cho/Cr(r=-0.204、r=-0.211,P值均0.05),MI/Cr(r=-0.243、r=-0.286,P值均0.05)呈负相关。此外,随着DEHSI的程度增加,NAA浓度,NAA/Cr和NAA/Cho比值下降(r=-0.320、r=-0.394、r=-0.565,P值均0.05),而Cho/Cr和MI/Cr增加(r=0.389、r=0.376,P值均0.05)。单因素方差分析:与正常组相比,轻度DEHSI组及中重度DEHSI组Cho/Cr和MI/Cr比值显著升高(P值均0.05),而NAA/Cr、NAA/Cho比值显著下降(P值均0.05)。结论生后年龄、胎龄、头围与DEHSI评估之间呈负相关;胎龄及生后年龄与新生儿脑组织代谢物水平有关;胎龄越大,胎儿越成熟,DEHSI分级越低,NAA浓度升高。  相似文献   

2.
目的:探究糖代谢异常对慢性缺血性脑白质疏松(LA)的影响。方法回顾性分析2013年6月~12月中国医科大学附属第四医院神经内科收治的258例缺血性脑血管疾病患者的临床资料。根据病史及化验结果将糖代谢情况分为正常糖代谢、2型糖尿病以及前驱期糖尿病,依据头MRI结果对LA严重程度进行分级,分析比较不同糖代谢情况以及不同血糖化验指标(包括FPG、2hPG及HbA1c)对慢性缺血性脑白质疏松及其严重程度的影响。结果单因素分析显示,慢性缺血性脑白质疏松的相关危险因素有年龄、高血压病史、糖尿病病史、糖代谢异常、甘油三酯、2hPG(OR>1,P<0.05)。Logistic回归分析显示脑白质疏松与年龄、高血压病史、2hPG相关(P<0.05)。Spearman秩相关检验显示LA严重程度分级与年龄大小、高血压病史时长、2hPG水平呈正相关,与HDL、apoA、腔梗病史呈负相关(P<0.05,r=0.402、0.227、0.135、-0.154、-0.147、-0.312)。结论年龄、高血压病史、糖尿病病史、糖代谢异常、2hPG、甘油三酯是脑白质疏松的危险因素;年龄越大、高血压病史时间越长、2hPG越高、HDL及apoA越低,脑白质疏松越严重;而FPG、HbA1c、前驱期糖尿病、糖尿病及其时长与脑白质疏松的严重程度无相关性。  相似文献   

3.
目的探讨振幅整合脑电图在早期评估脓毒症相关性脑病(SAE)预后中的临床应用价值。方法纳入SAE患儿45例, 在入院72 h内使用脑功能监测仪进行床旁监测, 收集患儿一般临床资料, 对振幅整合脑电图(aEEG)异常程度进行分级, 并完善Glasgow昏迷评分(GCS)及儿童危重症评分(PCIS), 以出院后3个月为期限对患儿进行儿童脑功能分类(PCPC)量表评估脑功能预后。应用Spearman秩相关分析aEEG与GCS评分及PCIS评分的相关性, 以及三者与PCPC脑功能预后评分的相关性, 并运用受试者工作曲线(ROC)评价aEEG、GCS评分及PCIS评分对脑功能预后的预测价值。结果 45例SAE患儿中预后不良的发生率为17.78%, 不同性别、年龄及感染部位神经系统预后不良发生率比较, 差异无统计学意义(P>0.05), 不同aEEG分级、GCS及PCIS评分分级神经系统预后不良发生率比较, 差异有统计学意义(P<0.05)。Spearman秩相关分析显示, aEEG分级与GCS评分及PCIS评分均呈负相关, 相关系数分别为r=-0.647(P=0.000)及r=-0.5...  相似文献   

4.
目的 应用三维超声检测新生儿侧脑室容积,探讨性别、胎龄、头围、体质量等因素对新生儿侧脑室容积的影响.方法 对255例新生儿以前囟为声窗行颅脑超声探测,获取冠状面第三脑室层面所有扫描数据进行三维重建,并计算侧脑室容积.结果 ①新生儿侧脑室容积与性别无相关性(P=0.809),与出生孕周呈负相关(r=-0.971),与头围呈正相关(r≥0.645),与体质量无相关性(P>0.05);②根据头围(X1)、胎龄(X2)与侧脑室容积(Y)的关系得到回归方程Y=2.298-0.011 X1-0.04 X2,确定系数R2为0.932;③新生儿左、右侧脑室容积差异无统计学意义(P=0.993).结论 胎龄为新生儿侧脑室容积的主要决定因素,头围为次要决定因素.脑发育不成熟可导致侧脑室增大.三维超声能准确测量新生儿侧脑室容积,有利于无创性评估新生儿脑发育及颅脑疾病的诊断.  相似文献   

5.
目的 探讨新生儿先天性心脏病患儿的血管紧张素Ⅱ(AngⅡ)、心房利钠肽(ANP)激活状况以及与心力衰竭的关系及其临床意义.方法 选取100例新生儿先天性心脏病患儿(NYHA心功能分级Ⅰ级组30例,Ⅱ级组40例以及Ⅲ和Ⅳ级组30例),另选取年龄及性别与之相匹配的正常体检新生儿30名作为对照组,检测AngⅡ、ANP浓度.结果 新生儿先天性心脏病患儿血循环中的AngⅡ与对照组比较明显增高,心功能分级3个亚组随着疾病严重程度的加重,AngⅡ的激活就越明显,其中Ⅲ和Ⅳ级组增高最明显[(119.19±5.54) ng/L与(30.72±1.34) ng/L,P<0.01];AngⅡ与心功能分级呈明显正相关(r=0.85,P<0.01).ANP与对照组比较明显增高,心功能分级3个亚组随着疾病严重程度的加重,ANP的增高越明显,其中Ⅲ和Ⅳ级组增加最明显[(9.00±2.37) pmol/L与(1.15±0.09) pmol/L,P<0.01];ANP与心功能分级呈明显正相关(r=0.79,P<0.01).结论 新生儿先天性心脏病存在AngⅡ及ANP的明显激活,并与疾病的严重程度密切相关;检测AngⅡ及ANP浓度可推测患儿的心功能状况.  相似文献   

6.
目的 初探肾病综合征(NS)的高脂血症的发病机制与其血胆红素的关系.方法 患儿禁食6h,空腹抽取静脉血检测总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)、甘油三酯(TG)、总胆固醇(CHO)、载脂蛋白B(APOB)、低密度脂蛋白(LDL-C)、载脂蛋白(a) (APOA).结果 NS组血清中TBIL、DBIL、IBIL、均低于正常对照组和肾炎组;NS组血清中TG、CHO、LDL、APOB、LDL-C、APOA均高于正常对照组和肾炎组(P<0.01);胆红素与TG、CHO采用相关性分析:TBIL与CHO、TG呈负相关(r=-0.55、P<0.01;r=-0.41,P<0.01);DBIL与CHO、TG呈负相关(r=-0.61,P<0.01;r=-0.45,P<0.01);IBIL与CHO、TG呈负相关(r=-0.52,P<0.01;r=-0.36,P<0.01).结论 胆红素水平与NS患者血脂的高低呈负相关,NS的血胆红素水平明显偏低.  相似文献   

7.
目的探讨新生儿缺氧缺血性脑病(HIE)脐血皮质醇(COR)水平的变化,为合理干预提供理论依据。方法选择成都市第一人民医院新生儿科病房2014年1月至2017年5月足月HIE患儿66例作为研究对象,根据HIE诊断标准分为轻度HIE组44例、中度HIE组15例、重度HIE组7例;另外选择健康足月新生儿50例作为健康对照组。检测各组新生儿脐血血清COR水平并进行比较;在出生第14天进行20项新生儿行为神经测定(NBNA)评分,对COR水平及出生第14天的NBNA进行相关性分析。结果轻、中、重度HIE组COR水平均高于健康对照组(nmol/L:667.37±156.77、923.50±198.44、1 174.10±223.84比453.47±142.14,均P0.05),且HIE临床分级越严重,脐血COR水平越高;相关性分析显示,脐血COR水平与出生第14天NBNA评分呈显著负相关(r=-0.850,P0.01)。结论脐血COR水平可作为HIE早期诊断和病情评估的参考指标,与HIE临床分级有较好的相关性,同时也可作为近期预后的指标。  相似文献   

8.
目的应用磁共振扩散张量成像(diffusion tensor imaging,DTI)及扩散张量纤维束成像(diffusion tensor tracking,DTT),探讨其对脑瘫患儿颈总动脉交感神经网剥脱术后脑白质恢复的评估价值。材料与方法对30例痉挛型单侧脑瘫患儿手术前、后进行临床评估和常规MRI、DTI检查,测量并比较术前术侧和对侧、术前和术后双侧内囊后肢及大脑脚的各向异性分数(fractional anisotropy,FA)值,并对白质纤维束进行三维重建。运用粗大运动功能分级系统(gross motor function classification system,GMFCS)评价患儿运动功能。采用配对样本t检验比较术前术侧和对侧、术前和术后脑白质不同部位FA值的差异,以Spearman相关分析不同白质纤维束DTI参量与GMFCS的相关性。结果术前术侧不同部位白质纤维束FA值均显著低于对侧,差异有统计学意义(P0.01)。术后6个月脑瘫患儿术侧不同部位白质纤维束FA值与术前相比显著增加(P0.01),粗大运动功能获得改善。术后6个月患儿对侧不同部位白质纤维束FA值与术前相比差异无统计学意义(P0.05)。患儿临床GMFCS与FA值呈负相关(P0.01),且与内囊后肢、大脑脚的相关性都较高(r=-0.933,P0.01;r=-0.873,P0.01)。结论 DTI联合DTT可用于定量评价脑瘫患儿术后脑白质的恢复情况,对辅助临床治疗和预后评估具有重要作用。  相似文献   

9.
目的探讨新生儿血清甲状腺激素水平与胎龄、出生体重的关系。方法用化学发光免疫分析法测定不同胎龄、出生体重新生儿血清T3、T4、TSH水平,分别按胎龄和出生体重进行分组比较,并对胎龄、出生体重与甲状腺激素(T3、T4、TSH)行相关性分析。结果随着胎龄、出生体重的增加,新生儿血清T3、T4水平升高(P0.05),TSH无显著性差异(P0.05);新生儿胎龄、出生体重与血清T3、T4水平亦呈正相关(P0.05),而与血清TSH水平无相关性(P0.05)。结论胎龄越小或出生体重越低,血清T3、T4水平越低,而TSH基本正常。新生儿血清T3、T4水平与胎龄及出生体重呈显著正相关。  相似文献   

10.
目的 分析老年患者血管源性脑白质病变与血游离脂肪酸的相关性。方法 纳入2020年9月-2021年7月在吉林大学中日联谊医院南湖神经内科住院的脑小血管病患者194例,根据头MR显示的脑白质病变程度进行Fazekas评分,按照评分结果对纳入患者进行分级。收集患者的一般资料、低密度脂蛋白胆固醇、血同型半胱氨酸及血游离脂肪酸等数据。比较不同程度脑白质病变患者的一般资料及血游离脂肪酸。结果 (1)不同程度的脑白质病变患者在吸烟史、高血压病史、年龄、同型半胱氨酸、月桂酸、山嵛酸、花生酸、硬脂酸、二十二碳六烯酸、二十碳五烯酸存在明显差异(P<0.05);(2)血游离脂肪酸与脑白质病变分级的相关性分析:月桂酸(r=-0.314,P<0.001)、山嵛酸(r=-0.164,P=0.022)、硬脂酸(r=0.182,P=0.011),二十二碳六烯酸(r=0.149,P=0.038),二十碳五烯酸(r=-0.0167,P=0.020)存在差异(P<0.05);(3)对脑白质病变分级行多因素logistic回归分析显示年龄、高血压病史、月桂酸、同型半胱氨酸、硬脂酸与脑白质病变严重程度存在独立...  相似文献   

11.
Preterm birth is a leading risk factor for neurodevelopmental and cognitive impairment in childhood and adolescence. The most common known cerebral abnormality among preterm infants at term equivalent age is a diffuse white matter abnormality seen on magnetic resonance (MR) images. It occurs with a similar prevalence to subsequent impairment, but its effect on developing neural systems is unknown. MR images were obtained at term equivalent age from 62 infants born at 24-33 completed weeks gestation and 12 term born controls. Tissue damage was quantified using diffusion-weighted imaging, and deformation-based morphometry was used to make a non-subjective survey of the whole brain to identify significant cerebral morphological alterations associated with preterm birth and with diffuse white matter injury. Preterm infants at term equivalent age had reduced thalamic and lentiform volumes without evidence of acute injury in these regions (t = 5.81, P < 0.05), and these alterations were more marked with increasing prematurity (t = 7.13, P < 0.05 for infants born at less than 28 weeks) and in infants with diffuse white matter injury (t = 6.43, P < 0.05). The identification of deep grey matter growth failure in association with diffuse white matter injury suggests that white matter injury is not an isolated phenomenon, but rather, it is associated with the maldevelopment of remote structures. This could be mediated by a disturbance to corticothalamic connectivity during a critical period in cerebral development. Deformation-based morphometry is a powerful tool for modelling the developing brain in health and disease, and can be used to test putative aetiological factors for injury.  相似文献   

12.
《Clinical therapeutics》2022,44(4):612-621
PurposeTo review and synthesize the literature on human milk and structural brain development and injury in preterm infants, focusing on the application of quantitative brain magnetic resonance imaging (MRI) in this field.MethodsFor this narrative review, we searched PubMed for articles published from 1990 to 2021 that reported observational or interventional studies of maternal milk or donor milk in relation to brain development and/or injury in preterm infants assessed with quantitative MRI at term equivalent age. Studies were characterized with respect to key aspects of study design, milk exposure definition, and MRI outcomes.FindingsWe identified 7 relevant studies, all of which were observational in design and published between 2013 and 2021. Included preterm infants were born at or below 33 weeks’ gestation. Sample sizes ranged from 22 to 377 infants. Exposure to human milk included both maternal and donor milk. No study included a full-term comparison group. Main MRI outcome domains were white matter integrity (assessed with diffusion tensor imaging, resting state functional connectivity, or semiautomated segmentation of white matter abnormality) and total and regional brain volumes. Studies revealed that greater exposure to human milk versus formula was associated with favorable outcomes, including more mature and connected cerebral white matter with less injury and larger regional brain volumes, notably in the deep nuclear gray matter, amygdala-hippocampus, and cerebellum. No consistent signature effect of human milk exposure was found; instead, the beneficial associations were regional and tissue-specific neuroprotective effects on the areas of known vulnerability in the preterm infant.ImplicationsEvidence to date suggests that human milk may protect the preterm infant from the white matter injury and dysmaturation to which this population is vulnerable. Brain MRI at term equivalent age is emerging as a useful tool to investigate the effects of human milk on the preterm brain. When grounded in neurobiological knowledge about preterm brain injury and development, this approach holds promise for allowing further insight into the mechanisms and pathways underlying beneficial associations of human milk with neurodevelopmental outcomes in this population and in the investigation of specific milk bioactive components with neuroprotective or neurorestorative potential.  相似文献   

13.
目的 探讨Hammersmith婴儿神经学检查(HINE)联合头颅MRI检测对脑瘫高危儿12月龄诊断脑瘫和运动发育迟缓的预测价值。 方法 选取矫正2~6月龄行HINE和头颅MRI检查的脑瘫高危儿45例,随访至矫正12月龄,最终完成随访共36例,采用Peabody运动发育量表(PDMS)对其运动发育程度进行评估,分为正常组(21例)、迟缓组(8例)和脑瘫组(7例)。根据头颅MRI检测Woodward白质评分法评价患儿的脑白质异常程度,计算2~6月龄HINE得分、12月龄HINE得分与头颅MRI脑白质异常程度之间的Spearman系数,计算2~6月龄HINE得分与脑瘫严重程度和迟缓严重程度之间的Spearman系数,计算单独使用HINE、头颅MRI及其联合使用与婴儿发育结局之间的Spearman系数。采用受试者工作特征曲线(ROC)描绘单独使用HINE、头颅MRI、HINE或头颅MRI异常、HINE且头颅MRI异常四个指标预测矫正12月龄时诊断脑瘫和迟缓的曲线下面积(AUC),并评价其预测价值。 结果 ①36例高危儿中,12例HINE得分预测为脑瘫;头颅MRI脑白质评分,中重度异常9例,轻度异常9例,无异常18例;随访至矫正12月龄,发育正常21例,运动发育迟缓8例(7例差,1例非常差),脑瘫7例,其中脑瘫粗大运动功能分级系统(GMFCS)分级Ⅲ级2例,Ⅳ级4例,Ⅴ级1例。②2~6月HINE得分与脑瘫严重程度分级(r=-0.867,P=0.012)、迟缓严重程度(r=-0.598,P=0.000)之间均具有相关性,HINE得分越低其预后越差。③矫正2~6月龄HINE得分和12月龄HINE得分与头颅MRI的脑白质异常程度之间均具有相关性(r值分别为-0.790和-0.683,P值均为0.000)。④HINE、头颅MRI、HINE或头颅MRI异常、HINE且头颅MRI异常与脑瘫和迟缓结局均具有相关性(r值分别为0.644、0.772、0.572、0.839和0.781、0.783、0.714、0.944,P值均为0.000);预测脑瘫和迟缓结局诊断的敏感性分别为100.0%、100.0%、100.0%、100.0%和93.3%、93.3%、100.0%、93.3%,特异性分别为82.8%、93.1%、79.3%、96.6%和85.7%、81.0%、71.4%、100.0%,AUC值分别为0.914、0.966、0.897、0.983和0.895、0.871、0.857、0.967(P值均为0.000)。 结论 HINE联合头颅MRI检测对脑瘫高危儿12月龄发育结局预测价值更高。  相似文献   

14.
Infants born preterm have a high incidence of neurodevelopmental impairment in later childhood, often associated with poorly defined cerebral white matter abnormalities. Diffusion tensor imaging quantifies the diffusion of water within tissues and can assess microstructural abnormalities in the developing preterm brain. Tract-based spatial statistics (TBSS) is an automated observer-independent method of aligning fractional anisotropy (FA) images from multiple subjects to allow groupwise comparisons of diffusion tensor imaging data. We applied TBSS to test the hypothesis that preterm infants have reduced fractional anisotropy in specific regions of white matter compared to term-born controls. We studied 26 preterm infants with no evidence of focal lesions on conventional magnetic resonance imaging (MRI) at term equivalent age and 6 healthy term-born control infants. We found that the centrum semiovale, frontal white matter and the genu of the corpus callosum showed significantly lower FA in the preterm group. Infants born at less than or equal to 28 weeks gestational age (n=11) displayed additional reductions in FA in the external capsule, the posterior aspect of the posterior limb of the internal capsule and the isthmus and middle portion of the body of the corpus callosum. This study demonstrates that TBSS provides an observer-independent method of identifying white matter abnormalities in the preterm brain at term equivalent age in the absence of focal lesions.  相似文献   

15.
目的 探讨3.0T MRI脑部弥散张量成像(diffusion tensor imaging,DTI)诊断老年轻度认知功能障碍(mild cognitive impairment,MCI)的价值.方法 对50例MCI患者及30例正常对照组,分别使用SIEMENS 3.0T MRI扫描,包括:头颅常规扫描、海马扫描和DT...  相似文献   

16.
Intrauterine growth restriction (IUGR) due to placental insufficiency affects 5-10% of all pregnancies and it is associated with a wide range of short- and long-term neurodevelopmental disorders. Prediction of neurodevelopmental outcomes in IUGR is among the clinical challenges of modern fetal medicine and pediatrics. In recent years several studies have used magnetic resonance imaging (MRI) to demonstrate differences in brain structure in IUGR subjects, but the ability to use MRI for individual predictive purposes in IUGR is limited. Recent research suggests that MRI in vivo access to brain connectivity might have the potential to help understanding cognitive and neurodevelopment processes. Specifically, MRI based connectomics is an emerging approach to extract information from MRI data that exhaustively maps inter-regional connectivity within the brain to build a graph model of its neural circuitry known as brain network. In the present study we used diffusion MRI based connectomics to obtain structural brain networks of a prospective cohort of one year old infants (32 controls and 24 IUGR) and analyze the existence of quantifiable brain reorganization of white matter circuitry in IUGR group by means of global and regional graph theory features of brain networks. Based on global and regional analyses of the brain network topology we demonstrated brain reorganization in IUGR infants at one year of age. Specifically, IUGR infants presented decreased global and local weighted efficiency, and a pattern of altered regional graph theory features. By means of binomial logistic regression, we also demonstrated that connectivity measures were associated with abnormal performance in later neurodevelopmental outcome as measured by Bayley Scale for Infant and Toddler Development, Third edition (BSID-III) at two years of age. These findings show the potential of diffusion MRI based connectomics and graph theory based network characteristics for estimating differences in the architecture of neural circuitry and developing imaging biomarkers of poor neurodevelopment outcome in infants with prenatal diseases.  相似文献   

17.
目的探讨老年首次短暂性脑缺血/轻型卒中患者认知功能障碍与脑白质高信号(WMHs)的关系。 方法选取2015年1月至2018年12月无锡市锡山人民医院神经内科收治的,符合标准的105例老年首次短暂性脑缺血/轻型卒中患者,均行头颅MRI等检查,患者认知障碍根据蒙特利尔认知评估量表(MoCA)评分结果分为无认知障碍组、暂时性认知障碍组和持续性认知障碍组。采用单因素方差分析比较3组间年龄、美国国立卫生院卒中量表评分、MoCA评分的差异,组间差异两两比较应用q检验;采用χ2检验比较组间性别(男性)、高血压、糖尿病、高脂血症、MRI影像改变及梗死部位的差异;采用多因素Logistic回归分析老年首次短暂性脑缺血/轻型卒中患者发生认知功能障碍的危险因素。 结果持续性认知障碍组患者的年龄、男性比例和WMHs比例高于无认知障碍组,差异均具有统计学意义(P<0.05);而在高血压、糖尿病、高脂血症、脑微出血、血管间隙扩大、腔隙性缺血灶、磁共振弥散加权成像(DWI)阳性病变及DWI显示脑梗死病变部位比较差异均无统计学意义(P均>0.05)。WMHs病变程度越严重,发生认知障碍的比例越高,差异具有统计学意义(P<0.05)。经校正年龄、性别、高血压、糖尿病等因素后,年龄和中-重度WMHs病变为老年首次短暂性脑缺血/轻型卒中后持续性认知功能障碍发生的独立危险因素(OR:1.08,95%CI:1.01~1.15,P=0.021;OR:1.66,95%CI:0.79~2.89,P=0.042)。 结论年龄和WMHs中-重度病变为老年首次短暂性脑缺血/轻型卒中患者第90天后发生持续性认知障碍的危险因素。  相似文献   

18.
This study examined frontal lobe subregions in 46 normal children and adolescents (25 females, mean age: 11.08, SD: 3.07; and 21 males, mean age: 10.76, SD: 2.61) to assess the effects of age and gender on volumetric measures as well as hemispheric asymmetries. Superior, middle, inferior, and orbito-frontal gray, white, and cerebrospinal (CSF) volumes were manually delineated in high-resolution magnetic resonance imaging (MRI) data to assess possible morphological changes. We report a significant age-related increase in the white matter of the left inferior frontal gyrus (IFG) in boys (P = 0.007). Additionally, the left IFG was significantly larger in boys compared to girls (P = 0.004). Boys showed increased gray matter volume relative to girls even after correcting for total cerebral volume. Also, boys were found to have significant Right > Left asymmetry patterns with greater right hemispheric volumes for total cerebral volume, total cerebral white matter, MFG white matter, and SFG white matter (P < 0.001). Girls showed significant Right > Left asymmetry patterns in total cerebral and SFG white matter (P < 0.001). These findings suggest continued modification of the IFG during normal development in boys, and significant gender differences in IFG gray matter between boys and girls that may be possibly linked to gender differences in speech development and lateralization of language.  相似文献   

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