磁共振形态学半定量评分对新生儿细菌性脑膜炎出院结局的评估价值

目的 分析MRI形态学半定量评分对新生儿细菌性脑膜炎出院结局的评估价值。方法 收集复旦大学附属儿科医院2011年7月至2013年12月NICU收治的出院诊断为新生儿细菌性脑膜炎的病例，采用基于大脑损伤MRI形态学分析的半定量评分，对头颅MRI图像进行回顾性分析。MRI形态学评价包括脑室扩大、脑室旁白质容积丢失、脑白质囊性病灶、内囊后肢髓鞘化异常、皮质信号异常、颅内脑外间隙异常、基底节信号异常、脑白质非囊性信号异常、脑室内出血、脑室积脓、脑膜异常强化、室管膜异常强化和脑脓肿。将上述13项评分归纳为脑白质异常（WMA）、脑灰质异常（GMA）和非脑实质异常（NPA）。同时采集患儿出生孕周、发病时间、MRI检查时间、发病至MRI检查间隔时间和出院结局。按照出生孕周分为早产儿组和足月儿组，再按照出院结局分为预后良好和预后不良亚组，在各组内比较亚组之间时间因素、MRI单项评分和综合评分的差异。结果 63例新生儿细菌性脑膜炎病例进入分析（早产儿组18例，足月儿组45例）。MRI单项评分构成预后良好和预后不良亚组间差异有统计学意义的指标：早产儿组中有脑室扩大(P=0.012)和脑室旁白质容积丢失(P=0.004)；足月儿组有脑室扩大(P=0.002)、脑室旁容积丢失(P=0.040)、颅内脑外间隙异常(P=0.005)和脑室内出血(P=0.038)。MRI综合评分中，早产儿组WMA评分(P=0.001)和NPA评分（P=0.039）、足月儿组NPA评分(P=0.018)在预后不良和预后良好亚组之间分布差异有统计学意义。足月儿组和早产儿组内不同预后亚组的各时间因素差异未发现统计学意义或临床意义。结论 新生儿细菌性脑膜炎MRI脑室扩大和脑室旁白质容积丢失预示早产儿出院不良结局；脑室扩大、脑室旁白质容积丢失、颅内脑外间隙异常和脑室内出血预示足月儿出院不良结局。WMA评分高预示早产儿出院不良结局，NPA评分高预示早产儿和足月儿出院不良结局。

Predicting the outcomes at discharge of neonatal bacterial meningitis: a semi-quantitative MRI-based-score system analysis

Objective To investigate the value of a semi-quantitative MRI-based-score system in predicting outcomes at discharge in infants with neonatal bacterial meningitis.Methods Newborns with a final diagnosis of neonatal meningitis were included in this study. The severities of thirteen patterns of brain injuries on cranial MR images of the infants were graded, which included ventricular dilatation, periventricular white matter volume loss, cystic abnormality, abnormal myelination of the posterior limb of the internal capsule, cortical gray matter signal abnormality, intracranial extracerebral space abnormality, basal ganglia signal abnormality, non-cystic white matter signal abnormality, intraventricular hemorrhage, pyocephalus, abnormal meningeal enhancement, abnormal ependymal enhancement and encephalopyosis. Except for encephalopyosis, the frequencies of white matter abnormality (WMA), gray matter abnormality (GMA), and non-brain-parenchyma abnormality (NPA) were also calculated. Four time factors and outcomes at discharge were collected from the clinical history of each patient. The patients were divided into preterm and term groups followed by cured and adverse outcome subgroups. The severity and spectrum of different part of cerebral injuries and time factors were compared between two subgroups of each group by using chi-square test, Mann-Whitney U test and student t-test. Results Sixty-three newborns including 18 preterm infants and 45 term ones were recruited in this study. There were significant differences in the scores of ventricular dilatation and periventricular white matter volume loss between cured and adverse outcome subgroups in preterm group (P value was 0.012 and 0.004, respectively). There were significant differences in the scores of ventricular dilatation, periventricular white matter volume loss, intracranial extracerebral space abnormality, and intraventricular hemorrhage between cured and adverse outcome subgroups in term group (P value was 0.002, 0.040, 0.005 and 0.038, respectively). There were significant differences in the scores of WMA, NPA in preterm group and NPA in term group between two outcome subgroups (P value was 0.001, 0.039 and 0.018, respectively). There was no significant difference with clinical value in time factors between outcome subgroups whether in preterm or term group.Conclusion Ventricular dilatation and periventricular white matter volume loss could predict adverse outcomes at discharge in preterm infants with neonatal bacterial meningitis. Ventricular dilatation, periventricular white matter volume loss, intracranial extracerebral space abnormality, and intraventricular hemorrhage could predict adverse outcomes at discharge in term infants with neonatal bacterial meningitis. Regarding to the significance of WMA, GMA and NPA types, high NPA scores could predict adverse outcomes at discharge in both preterm and term infants, while WMA scores could predict adverse outcomes at discharge in preterm ones.