Predictive value of plasma and cerebrospinal fluid tumour necrosis factor-alpha and interleukin-1 beta concentrations on outcome of full term infants with hypoxic-ischaemic encephalopathy

AIM: To determine the predictive value of plasma and cerebrospinal fluid (CSF) tumour necrosis factor-alpha (TNF-alpha) and interleukin-1 beta (IL-1 beta) concentrations on the outcome of hypoxic-ischaemic encephalopathy (HIE) in full term infants. METHODS: Thirty term infants with HIE were included in the study. HIE was classified according to the criteria of Sarnat and Sarnat. Blood and CSF were obtained within the first 24 hours of life and stored until assay. Five infants died soon after hypoxic insult. Neurological examinations and Denver Developmental Screening Test (DDST) were performed at 12 months in the survivors. RESULTS: At the age of 12 months neurological examination and DDST showed that 11 infants were normal; 14 had abnormal neurological findings and/or an abnormal DDST result. Eleven normal infants were classified as group 1 and 19 infants (14 with abnormal neurological findings and/or an abnormal DDST and five who died) as group 2. CSF IL-1 beta and TNF-alpha concentrations in group 2 were significantly higher than those in group 1. Plasma IL-1 beta and TNF-alpha concentrations were not significantly different between the two groups. IL-1 beta, but not TNF-alpha concentrations, in group 2 were even higher than those in group 1, although non-survivors were excluded from group 2. When the patients were evaluated according to the stages of Sarnat, the difference in the three groups was again significant. Patients whose CSF samples were taken within 6 hours of the hypoxic insult had higher IL-1 beta and TNF-alpha concentrations than the patients whose samples were taken after 6 hours. CONCLUSIONS: Both cytokines probably contribute to the damage sustained by the central nervous system after hypoxic insult. IL-1 beta seems to be a better predictor of HIE than TNF-alpha.     

新生儿缺氧缺血性脑病血浆及脑脊液乳酸的临床研究

目的　围产期窒息是引起新生儿脑损伤的重要原因之一 ,目前仍无确切的方法早期预测其预后。本实验研究缺氧缺血性脑病 (HIE)患儿血浆和脑脊液 (CSF)乳酸 (Lac)的变化 ,观察Lac与HIE及窒息的关系。方法　对 2 6例HIE患儿 (轻度 8例 ,中度 10例 ,重度 8例 )和 8例正常对照组 ,在生后 0～ 2 4h、4 8～ 72h及 7～ 10d抽取动脉血测Lac含量 ,HIE患儿生后 4 8～ 72h腰穿取CSF测Lac含量 ,并于生后 7～ 10d做头部MRI检查。结果　对照组和病例组血浆Lac均随日龄增加呈下降趋势 ,有统计学差异。生后 0～ 2 4h ,4 8～ 72hHIE组血浆Lac较对照组显著升高 (均P <0 .0 1)。重度HIE组血浆Lac(9.11± 3.2 9mmol/L)与轻、中度HIE组 (6 .0 3±2 .6 6mmol/L ,6 .5 6± 1.4 2mmol/L)相比较仅在 0～ 2 4h明显升高 (均P <0 .0 5 )。重度组CSFLac(2 .5 3±0 .2 7mmol/L)与轻、中度HIE(1.80± 0 .2 0mmol/L ,1.91± 0 .2 8mmol/L)相比有显著增高 (均 P <0 .0 1)。 5minApgar评分≤ 5分组CSFLac含量 (2 .4 3± 0 .34mmol/L)较 >5分组 (1.83± 0 .2 5mmol/L)明显升高 (t =5 .2 2 ,P<0 .0 1)。重度MRI改变的HIE患儿CSFLac较轻、中度MRI改变的HIE患儿CSFLac明显升高 (2 .36±0 .4 4mmol/Lvs 1.72± 0 .2 4mmol/L ,2 .14± 0 .2 6mmol/L     

一氧化碳和一氧化氮在新生儿缺氧缺血性脑病发病中的作用

目的：探讨一氧化碳（ＣＯ）和一氧化氮（ＮＯ）在新生儿缺氧缺血性脑病（ＨＩＥ）中的作用。方法：对２８例新生儿ＨＩＥ血浆ＣＯ和ＮＯ水平进行检测，并与３０例正常新生儿对照组比较。结果：与正常对照组比较，２８例新生儿ＨＩＥ患儿血浆ＣＯ、ＮＯ水平显著增高；与轻、中度新生儿ＨＩＥ患儿比较，重度者血浆ＣＯ、ＮＯ水平显著增高；ＣＯ和ＮＯ呈显著正相关。结论：ＣＯ和ＮＯ在新生儿ＨＩＥ的发病过程中具有重要意义。     

窒息新生儿脑干听觉诱发电位与血清神经元特异性烯醇化酶的相关性分析

目的：通过研究窒息患儿脑干听觉诱发电位（BAEP）异常与神经元特异性烯醇化酶（NSE）的相关性,探讨NSE对早期了解窒息患儿听神经损害的临床意义和应用前景。方法：选择该院窒息足月新生儿52例作为研究组,根据Apgar评分以及是否合并缺氧缺血性脑病(HIE)分为单纯轻度窒息组23例、单纯重度窒息组15例和窒息合并HIE组14例。采用双盲试验在生后7 d同一时间检测BAEP和NSE,初次BAEP检测异常者在生后3个月同一时间进行第2次BAEP和NSE检测。正常足月新生儿30例作为对照组。结果：窒息患儿两次听力损伤检出率分别为50.0%,21.2%。BAEP两次检出异常率,重度窒息组(63.3%,26.3%)与轻度窒息组(36.9%,5.9%)比较,差异均有显著性意义(P<0.05),HIE组(57.1%,31.3%)与重度窒息组比较差异无显著性意义。各研究组NSE水平均明显高于对照组(P<0.01),重度窒息组为26.70±2.34 μg/L明显高于轻度窒息组的17.18±3.16 μg/L,差异有显著性意义(P<0.01),HIE组为27.00±2.01 μg/L,与重度窒息组比较差异无显著性意义。BAEP异常组NSE水平为25.69±4.12 μg/L高于BAEP正常组的17.15±3.09 μg/L(P<0.01),NSE水平随着V波反应阈值的增高而增高(P<0.05)。结论：血清NSE水平与BAEP密切相关,可作为早期评估窒息患儿听神经损害和判断预后的指标之一。     

Serum leptin levels and their relationship to tumor necrosis factor-alpha and interleukin-6 in neonatal sepsis

Circulating leptin concentrations are raised in animal models of inflammation and sepsis and leptin production is also increased in rodents by administration of endotoxin or cytokines. The purpose of this study was to investigate the effect of sepsis on serum leptin concentration and whether circulating leptin was related to tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) release in newborn infants. Plasma leptin, TNF-alpha and IL-6 were measured in 20 neonates with culture-proven sepsis as soon as sepsis was diagnosed and after recovery and in 15 healthy control infants. There was no significant difference in plasma leptin levels between septic and control infants (p > 0.05); there was also no difference in plasma leptin levels in septic neonates before and after therapy (p > 0.05). No relationship between leptin and TNF-alpha (r = 0.16, p > 0.05) or IL-6 (r = 0.12, p > 0.05) was identified. These findings suggest that a major role of leptin in acute neonatal sepsis appears unlikely.     

Interleukin-6 in the cerebrospinal fluid after perinatal asphyxia is related to early and late neurological manifestations

OBJECTIVES: To investigate if the concentration of interleukin-6 (IL-6) in the cerebrospinal fluid (CSF) is affected by perinatal asphyxia, and to examine the relation of IL-6 levels in the CSF to the severity of hypoxic-ischemic encephalopathy (HIE), to brain damage, and to the neurological outcome. METHODS: Asphyxiated term neonates were included. Cerebrospinal fluid IL-6 was measured by a sensitive enzyme-linked immunosorbent assay. RESULTS: Twenty neonates were studied: 3 had no HIE, 5 had stage 1, 6 had stage 2, and 6 had stage 3. CSF IL-6 levels (8 to 90 hours of life) were higher in neonates with HIE stage 3 (range, 65 to 2250 pg/mL) when compared with neonates with HIE stage 0 to 2 (<2 pg/mL in 12 neonates, 10 pg/mL in 1). According to neuroimaging techniques and/or pathological examination, 14 neonates were normal, and 5 showed signs of brain damage; 1 was not classified. CSF IL-6 levels were significantly higher in neonates with signs of brain damage. Finally, 5 neonates had adverse outcomes (4 died, 1 had cerebral palsy), 2 had mild motor impairment, and 13 had normal outcomes. CSF IL-6 levels were higher in neonates with adverse outcomes (range, 65 to 2250 pg/mL) compared with neonates with favorable outcomes. CONCLUSION: The magnitude of IL-6 response in the CSF after perinatal asphyxia is related to the severity of neonatal HIE, to brain damage, and to the neurological outcome. Our results suggest that IL-6 might play a role in neonatal hypoxic-ischemic brain damage.     

Evaluation of interleukin-6, tumour necrosis factor-α and interleukin-1β for early diagnosis of neonatal sepsis

The objective of this study was to assess the contribution of interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-alpha) and interleukin-1beta (IL-1beta) to an early diagnosis of early-onset neonatal sepsis. A cohort of 117 newborn infants delivered during a 1-y period had IL-6, TNF-alpha and IL-1beta, blood and cerebrospinal fluid (CSF) cultures, leucocyte and platelet count collected on the initial evaluation of possible early-onset sepsis. They were divided into four groups: I, positive blood and/or CSF cultures; II, probably infected with clinical sepsis but negative cultures; III, same as group II but mother received antibiotic antepartum; and IV, newborn infants that did not receive any antibiotic therapy. There were no differences among the four groups with respect to mean gestational ages and birthweights, median Apgar scores, type of delivery, or number of newborn infants with leucocyte count <5000 mm(-3) or >25000 mm(-3), platelet count <100000 mm(-3), immature/total neutrophil ratio >0.2, absolute neutrophil count <1000mm(-3) and median IL-1beta levels. Median IL-6 and TNF-alpha levels were significantly higher in groups with patients with a diagnosis of clinical sepsis than in controls. The optimal cut-off point was 32 pg ml(-1) for IL-6 and 12 pg ml(-1) for TNF-alpha. The combination of both provided a sensitivity of 98.5%. In conclusion, the combination of IL-6 and TNF-alpha is a highly sensitive marker of sepsis in the immediate postnatal period.     

Elevation of cytokine concentrations in asphyxiated neonates

BACKGROUND: Various cytokines are reportedly associated with many neonatal diseases. Asphyxia is considered to result in ischemia-reperfusion injuries and induces abnormal inflammatory responses involving excessive cytokine production. OBJECTIVES: To evaluate alteration in sera levels of various cytokines/chemokines in case of perinatal asphyxia at birth. METHODS: In order to determine the concentrations of various cytokines/chemokines in sera, we used a highly sensitive fluorescence microsphere method. We measured the concentration of 8 types of cytokines/chemokines in sera obtained from 17 cases of asphyxia, 10 normal neonates, and 6 healthy adults. RESULTS: The concentrations of IL-6, IL-8, and IL-10 in the sera of asphyxiated neonates were higher than those in the normal neonates. Irrespective of the presence or absence of asphyxia, sera concentrations of IL-2, IL-4, IFN-gamma, and TNF-alpha were higher in the neonates than those in the adults. The concentration of IFN-gamma in the asphyxiated neonates was lower than that in the normal neonates. Sera levels of IL-10 were higher in the asphyxiated cases than those in the normal neonates. The sera levels of IL-6, IL-8, and IL-10 in asphyxiated neonates with either a poor outcome or death were higher than those without poor outcomes. CONCLUSIONS: The concentrations of various types of cytokines/chemokines were different in neonatal sera and some of them increased drastically during asphyxia. The concentration of an anti-inflammatory cytokine IL-10 was elevated in asphyxiated neonates immediately after birth, thereby suggesting that IL-10 might be associated with neuroprotective functions.     

Alterations in antioxidant enzyme activities in cerebrospinal fluid related with severity of hypoxic ischemic encephalopathy in newborns

BACKGROUND: The antioxidant status of the tissue affected by ischemia-reperfusion is of great importance for the primary endogenous defense against the free-radical-induced injury. OBJECTIVE: In this study, we aimed to evaluate the relationship between the activities of antioxidant enzymes [superoxide dismutase (SOD), glutathione peroxidase (GPX), and catalase (CAT)] in cerebrospinal fluid (CSF) and severity of hypoxic-ischemic encephalopathy (HIE) in newborns. METHODS: Thirty full-term asphyxiated infants (gestational age >37 weeks) and 11 full-term infants (none of whom showed any signs of asphyxia) were included in this study. Activities of SOD, GPX, and CAT in CSF were measured within the first 72 h of life in infants with HIE and controls. RESULTS: Activity of SOD in CSF was significantly higher in infants with HIE compared with controls (p<0.05). GPX and CAT activities were higher in infants with HIE than they were in controls; however, the differences were not statistically significant (p > 0.05). The activities of GPX and CAT were significantly increased in severe HIE as compared with mild HIE and controls (p < 0.05). CONCLUSION: Both the duration of the hypoxic-ischemic insult and the severity of HIE modulate elevations of enzymatic activity as an adaptive response to excessive free radical production in CSF in newborn infants with HIE. The activities of antioxidant enzyme alterations in CSF correspond highly to the severity of HIE, and these patterns may be useful for diagnostic and prognostic purposes.     

脑电图背景活动对窒息足月新生儿预后评估的研究

目的：新生儿期最常见的脑损伤疾病为新生儿重度窒息后的缺氧缺血性脑病（HIE）,可遗留神经系统后遗症。目前对新生儿HIE预后的判断方法除考虑异常围生期因素、常规神经系统体格检查外,只能依赖于颅内超声、CT、MRI等影像学方法,这些方法主要建立在解剖结构改变基础之上,而脑电图则能发现早期的脑功能异常。该研究的目的是通过对足月窒息新生儿脑电图背景活动的研究,检测并评估与窒息新生儿预后相关的参数,并根据数理原理得出并证明这些参数对预后判断的价值。方法：对80名生后24 h至日龄<8 d的足月新生儿（对照组31人,窒息组49人）脑电图进行平行对照的前瞻性分析,并在出院后对窒息组患儿进行6~12个月的随访。结果：①窒息患儿交替性脑电活动期平均阵发性放电间期延长,振幅降低,阵发性活动、异常尖波频率出现率和睡眠周期循环障碍的发生率增加。②对窒息患儿预后判断有重要意义的参数为胎龄、出生体重、脑电活动振幅均值、睡眠循环障碍、影像学异常改变、HIE分级。③出生24 h后脑电图仍表现为平坦波或平坦波伴大量异常放电患儿预后极差。结论：脑电图背景活动是足月窒息新生儿预后判断的有效工具,如结合患儿脑电图背景活动及其胎龄、出生体重、影像学检查、HIE分级等临床指标,可使预后判断更为准确。［中国当代儿科杂志,2007,9（5）：425-428］     

Inflammatory mediators in perinatal asphyxia and infection

AIM: To determine serum levels of interleukin-6 (IL-6), IL-1beta, tumor necrosis factor-alpha (TNF-alpha), soluble intercellular adhesion molecule-1 (sICAM-1) and C-reactive protein (CRP) in asphyxiated neonates and compare these inflammatory factors with those found in neonates with perinatal infection. METHODS: 88 neonates were studied, of whom 36 were asphyxiated, 18 were infected and the remaining 34 were controls. Peripheral blood samples were obtained on the 1st, 3rd and 5th postnatal days. RESULTS: Cytokines IL-6 and IL-1beta as well as sICAM-1 serum levels did not differ between asphyxiated and infected neonates; however, at most time periods, their values were significantly higher than controls. TNF-alpha was similar in the three groups of neonates. CRP serum values were significantly higher in the infected neonates than in the asphyxiated or control subjects. Among the 54 asphyxiated and infected neonates, 15 were considered as severe cases and 39 as mild. The severe cases, at most time periods, had significantly higher IL-6, IL-1beta and sICAM-1 levels compared with the mild ones. Through receiver operating characteristic curves the cut-off points, sensitivities, and specificities for distinguishing neonates at risk or at high risk for brain damage were established. CONCLUSION: Similar increases in serum levels of IL-6, IL-1beta and sICAM-1 were found in perinatally asphyxiated and infected neonates. As these increases correlated with the severity of the perinatal insults, neonates at high risk for brain damage might be detected.     

一氧化碳和一氧化氮在新生儿缺氧缺血性脑病中的变化与神经行为测定的关系

目的　 探讨一氧化碳 (CO)和一氧化氮 (NO)在新生儿缺氧缺血性脑病 (HIE)中的作用 ,与新生儿神经行为测定(NBNA)之间的关系及早期评估预后的价值 ,以便及时给予正确治疗。 方法 　对 5 1例新生儿HIE患儿血浆CO和NO水平进行检测 ,并与 2 0例正常新生儿对照组比较 ,同时结合 2 0项新生儿神经行为测定。 结果 　与正常新生儿对照组比较 ,5 1例新生儿HIE患儿血浆CO、NO水平显著增高 ,但轻、中度新生儿HIE两组之间NO水平无显著性差异 ,而重度者血浆CO、NO水平显著增高 ,并且病情程度与NBNA评分呈负相关。 结论 　CO和NO在新生儿HIE的发病过程中具有重要意义 ,而且CO和NO的变化与NBNA之间也具有一定关系。     

Elevation of Plasma Concentrations of Arginine Vasopressin Following Perinatal Asphyxia

Hypoxic ischemic encephalopathy is a major cause of mortality in neonates. Studies in experimental subjects have shown differing responses of plasma arginine vasopressin to hypoxia. Plasma arginine vasopressin levels, serum osmolality, urine osmolality and fluid intakes were measured in thirteen asphyxiated and nineteen control newborn infants during the first seventy-two hours of life. In the asphyxiated infants plasma arginine vasopressin was found to be elevated as compared to control infants on days one ( p < 0.001) and two ( p < 0.007) but not on day three of life. Urine osmolality was also elevated in the study patients on days one ( p < 0.01) and two ( p < 0.001) but not on day three, in spite of equal intakes of fluid on day one in both groups and significantly diminished fluid intake on days two and three in the study patients. Serum osmolality was not different between the two groups on any day studied, and was felt to be on the basis of diminished intake in the study infants. The data presented in this study support the concept that arginine vasopressin release occurs following perinatal asphyxia in term newborn infants     

The relationship of CSF and plasma cytokine levels to cerebral white matter injury in the premature newborn

Ischemia and systemic infection are implicated in the etiology of periventricular white matter injury, a major cause of adverse motor and cognitive outcome in preterm infants. Cytokines are signaling proteins that can be produced as part of the inflammatory response to both ischemia and infection. The aim of this study was to relate cerebrospinal fluid (CSF) concentrations of IL-6, IL-8, IL-10, tumor necrosis factor alpha (TNF-alpha), and interferon gamma (IFN-gamma) to magnetic resonance-defined white matter injury in preterm infants. Relationships between CSF and plasma cytokine concentrations were also examined. Preterm infants (相似文献   

谷氨酸和一氧化氮与新生儿缺氧缺血性脑病的关系探讨

为探讨脑脊液谷氨酸和一氧化氮（NO）水平变化在新生儿缺氧缺血性脑病（HIE）中的作用及相互关系。对24例HIE新生儿脑脊液谷氨酸和NO水平进行检测,并与8例对照组比较。结果：中、重度HIE组脑脊液谷氨酸和NO水平明显高于对照组及轻度HIE组;谷氨酸和NO呈显著正相关,提示谷氨酸和NO在新生儿HIE的发生和发展过程中具有重要意义。     

Arachidonic acid metabolites in CSF in hypoxic-ischaemic encephalopathy of newborn infants

The aim of this study was to evaluate the cerebral synthesis of eicosanoids in the asphyctic newborn and to investigate the relation between the prostanoid profiles in cerebrospinal fluid (CSF) and the appearance and severity of hypoxic-ischaemic encephalopathy (HIE). Levels of 6-keto-PGF _1-α, TXB₂, PGE₂ and PGF_2-α in CSF were measured in 40 full term newborns during the first day of life. Thirty of these newborns had birth asphyxia and were divided into three groups: 10 without HIE, 12 with mild HIE and 8 with moderate-severe HIE. They were compared to a control group of 10 non-hypoxic newborns. Determinations of the metabolites in CSF were performed by RIA and expressed as pg/ml (mean ± SD). The CSF TXB₂ (thromboxane A₂ metabolite) in asphyxiated newborns was always higher than in the control group (28.12 ± 10.6), and related to the severity of HIE ( p = 0:005): without HIE (50.84 ± 16.4; p = 0:02), mild HIE (80.65 ± 12.64; p ± 0:01) and moderate-severe HIE (178.14 ± 20.5; p < 0:01). The CSF 6-keto-PGF _1-α (prostacyclin metabolite) in asphyxiated newborns was always higher than in the control group (80.55 ± 12.56), but indirectly related to the severity of HIE: without HIE (240.95 ± 28.12; p < 0:01), mild HIE (183.65 ± 30.1; p < 0:01) and moderate-severe HIE (140.55 ± 25.12; p < 0:01). In the moderate-severe HIE group, the increase in TXB₂ was higher than the rise in 6-keto-PGF _1-α.     

新生儿缺氧缺血性脑病血浆及脑脊液血小板活化因子的变化

目的　观察新生儿缺氧缺血性脑病 (HIE)血浆及脑脊液 (CSF)血小板活化因子 (PAF)的变化 ,探讨PAF在HIE发病中的作用。方法　于急性期和恢复期分别采集患儿血浆和CSF ,采用生物活性法检测血浆及CSF中PAF水平 ,并分析其与脑损伤和 1minApgar评分的关系。 结果　 1.HIE患儿急性期CSF中PAF水平明显高于对照组患儿 (P <0 .0 1) ,且与病情轻重呈明显正相关 (r =0 .6 5　P <0 .0 1) ;急性期中度与重度HIE患儿血浆PAF水平显著高于对照组 (P <0 .0 1) ,且与病情轻重呈明显正相关 (r =0 .5 9　P <0 .0 1) ,而轻度患儿与对照组无明显差异 (P >0 .0 5 ) ;恢复期与对照组比较无显著差异。 2 .血浆PAF水平与CSF中PAF水平呈正相关 ,血浆及CSF中PAF水平与脑损伤程度及 1minApgar评分呈明显正相关。 结论　PAF可能参与新生儿HIE的发病机制 ,CSF中PAF水平可作为判断HIE病情轻重和预后的重要指标     

窒息新生儿凝血功能状态的研究

目的探讨窒息足月、早产新生儿凝血功能的变化。方法检测10例正常儿、44例窒息足月儿、32例窒息早产儿凝血指标。结果与对照组比较,窒息足月儿PT、APTT、FIB、PLT无显著差异,D-D明显升高,且与窒息程度正相关。窒息早产儿与窒息足月儿比较PT、APTT延长,FIB、PLT降低,D-D无明显差异。结论窒息足月儿大都存有高凝为特征的前DIC或DIC早期;窒息早产儿更易发生DIC,且有向低凝期发展的趋势。     

Auditory brainstem response in neonates with hypoxic-ischemic-encephalopathy following perinatal asphyxia.

The technique of auditory brainstem evoked responses testing (ABR) was applied to twenty four new born infants with asphyxia complicated by hypoxic-ischemic-encephalopathy (HIE) in an attempt to study potential influence of HIE on hearing impairment. Twenty normal term neonates with no apparent neurological disorder, were also examined for comparison. Twenty two per cent (n = 5) of the patients with HIE showed some abnormality in the ABR pattern, the major one being a transient elevation in threshold of wave V (n = 4; 16.6%). ABR abnormalities, however, were found with greater frequency in neonates with Stage II HIE (75% vs 10%, p less than 0.001). Further ABR abnormalities were found in Stage II HIE only when duration of neurological abnormalities was greater than 5 days. There was no difference, however, between the ABR latencies of the asphyxiated and non-asphyxiated newborn infants (p greater than 0.05). One neonate (4%) with severe HIE, however, had persistent ABR abnormality in the form of bilateral absence of all waves in the later part of the ABR with preservation of wave I. This implied only cochlear functions and absence of any brainstem conduction. These results indicate that birth asphyxia complicated by HIE is a significant high risk factor for hearing impairment in the affected neonates. This justifies ABR testing of neonates with HIE (particularly Stage III), at the time of their discharge, as a screening procedure for early detection of permanent hearing loss.     

新生儿缺氧缺血性脑病MRI和1HMRS检查的临床意义

目的 研究新生儿缺氧缺血性脑病（ＨＩＥ）时脑形态学及代谢改变,并探讨其与临床的关系。方法 对２１你ＨＩＥ新生儿进行头颅ＭＲＩ和＾１ＨＭＲＳ检查,并以７例无窒息史的新生儿作为对照。结果 ＭＲＩ显示ＨＩＥ患儿均存在不同程度的脑水肿,但脑水肿的范围轻度组与中、重度组无明显差异（Ｐ〉０．０６）,而脑实质及基底节区出血发生率中、重度组高于轻度组（Ｐ〈０．０５）。＾１ＨＭＲＳ显示缺氧早期决肌酸／乳酸（Ｌａｃ／