新生儿胆红素脑病脑脊液总胆红素及颅脑MRI检查的临床意义

目的探讨新生儿胆红素脑病脑脊液总胆红素水平的变化及颅脑MRI特征改变的临床意义。方法使用全自动生化分析仪、采用钒酸盐氧化法检测44例胆红素脑病组和79例非胆红素脑病组血清总胆红素水平及脑脊液总胆红素水平,并对2组行颅脑MRI检查。结果胆红素脑病组脑脊液、血清总胆红素水平均显著高于非胆红素脑病组(均P<0.01)。胆红素脑病组MRI表现为T1WI苍白球对称性高信号33例,其他部位高信号7例(MRI表现为1例右侧基底节区内囊后肢外侧小片状异常信号、1例右侧尾状核头T1WI高信号、3例侧脑室旁异常信号、1例双侧额叶异常信号和1例窦汇处短T1T2信号),MRI未见异常信号4例。非胆红素脑病组MRI表现为T1WI苍白球对称性高信号3例,其他部位高信号1例(MRI表现为1例右侧顶枕部点状异常信号),MRI未见异常信号75例。胆红素脑病组MRI T1WI苍白球对称性高信号发生率明显高于非胆红素脑病组(P<0.01)。结论脑脊液总胆红素水平检测可作为胆红素脑病早期诊断的可靠指标,胆红素脑病新生儿早期颅脑MRI主要特征为T1WI苍白球对称性高信号,需定期随访并早期干预治疗。

Clinical Significance of Cerebrospinal Fluid Bilirubin and Craniocerebral Magnetic Resonance Imaging Measurements in Newborns with Bilirubin Encephalopathy

Objective To explore the clinical significance of changes in cerebrospinal fluid bilirubin levels and craniocerebral magnetic resonance imaging （MRI）features in newborns with bilir-ubin encephalopathy. Methods Total bilirubin levels in serum and cerebrospinal fluid were determined using vanadate oxidation method with automatic biochemical analyzer in 44 newborns with bilirubin encephalopathy （bilirubin encephalopathy group）and 79 newborns without bilirubin enceph-alopathy （non-bilirubin encephalopathy group）.In addition,craniocerebral MRI was performed in both groups. Results Total bilirubin levels in serum and cerebrospinal fluid in bilirubin encephalopathy group were significantly higher than those in non-bilirubin encephalopathy group （P〈0.01）.In bilirubin enceph-alopathy group,MRI showed symmetrical high signal intensity in the globus pallidus on T1WI in 33 newborns,abnormal signal in lateral side of posterior limb of internal capsule in the right basal ganglion region in 1 newborn,high signal intensity in the head of the right caudate nucleus on T1WI in 1 newborn, abnormal signal in the lateral ventricle in 3 newborns,abnormal signal in the bilateral frontal lobes in 1 newborn, short T1T2 signal in the torcular herophili in 1 newborn,and normal signal in 4 newborns. In non-bilirubin encephalopathy group,MRI showed symmetrical high signal intensity in the globus pallidus on T1WI in 3 newborns, abnormal signal in the right side of top occipital in 1 newborn, and normal signal in 75 newborns. The incidence of symmetrical high T1WI signal intensity in the globus pallidus in bilirubin encephalopathy group was significantly higher than that in non-bilirubin encephalopathy group （P〈0.01）.Conclusion Cerebrospinal fluid bilirubin can be used as a reliable indicator for the early diagnosis of bilirubin encephalopathy. The symmetrical high signal intensity in the globus pallidus on T1WI is the main feature of bilirubin encephalopathy in newborns. Regular fol-low-up and early intervention treatme