| Objectives:Neonatal bilirubin encephalopathy in the neonatal period because of severe hyperbilirubinemia,and in a variety of factors caused by central nervous system dysfunction.When severe hyperbilirubinemia,will cause damage to the central nervous system in children,early detection of changes in the central nervous system in children,for children with early discovery and early treatment to help provide beneficial.In this study,we summarized and analyzed the changes in neonatal hyperbilirubinemia magnetic resonance spectroscopy brain metabolites of the globus pallidus;To investigate the diagnostic value of magnetic resonance spectroscopy for neonatal bilirubin encephalopathy,compared to the globus pallidus whether there are differences in hyperbilirubinemia and normal neonatal brain metabolic changes,assess the impact of the situation on neonatal bilirubin globus pallidus;To explore the relationship between total bilirubin levels and the metabolites of globus pallidus when severe hyperglycemia occurs.To improve the diagnostic efficacy of1H-MRS in neonatal bilirubin encephalopathy,to provide new diagnostic methods for clinical and to explore the pathophysiological changes of bilirubin encephalopathy put forward new possibilities.Objects and methods:1.Objects of study:Twenty-seven children with severe bilirubinemia were enrolled in this study.The birth time was 5-28 days,with an average of 11.7 days.Another 25 cases of neonates without central nervous system disease and no history of asphyxia were studied as the control group.The birth time was 1-28 days,with an average of 13.1 days.2.MRI examination:Routine MR and1H-MRS were examined for all newborns.Scanning sequence: The GE3.0T superconducting magnetic resonance scanner,scanning sequence including axial and sagittal T1-weighted(T1W)for the Flair sequence;axial T2-weighted(T2WI)for theFSE sequence;liquid attenuation inversion recovery FLAIR);diffusion weighted imaging(DWI)using SE-EPI;1H-MRS imaging: Multi-voxel scanning of basal ganglia with fixed-point resolution spectral sequence(PRESS).Determination of the left and right sides of the globus pallidus metabolites,included N-acetylasparate(NAA),creatine(Cr),choline(Cho),Glutamine complexes-α(α-Glx)and Glutamine complexes-β 、 γ(β 、 γ-Glx),and the data to be analyzed were NAA/Cr、Cho/Cr、NAA/Cho、α-Glx/Cr and β、γ-Glx/Cr.3.Statistical analysis:1H-MRS analysis of data obtained with the mean±standard deviation(x±s),using SPSS 22 software for statistical analysis,two different groups of samples were compared using independent sample Wilcoxon rank sum test,statistically P <0.05 for the difference significance.Using the receiver operating characteristic(ROC)curves for each feasibility1H-MRS metabolites bilirubin encephalopathy discrimination analysis,the measured area under the curve(AUC),and AUC> 0.8 for each data set,joint diagnostic multivariate ROC curve analysis were measured sensitivity and specificity of each ROC curve.Rank correlation between the total bilirubin and the resulting α-Glx/Cr and β 、 γ-Glx/Cr of1H-MRS analysis metabolite case group.Result:1.The case group and control group globus pallidus metabolite left and right sides pairwise independent samples t-testThe left globus pallidus patient group were larger than the control group NAA/Cr[(1.13±0.07)and(0.99±0.09),H=4.588 P<0.05]、Cho/Cr[(1.49±0.12)and(1.31±0.11),H=4.533 P<0.05]、NAA/Cho[(0.76±0.06)and(0.77±0.09),H=0.156P=0.876] 、 α-Glx/Cr[(0.15±0.03)and(0.13±0.04),H=2.628 P<0.05] 、 β 、γ-Glx/Cr[(0.52±0.07)and(0.43±0.05),H=4.496 P<0.05];The right globus pallidus patient group were larger than the control group NAA/Cr[(1.10±0.11)and(0.98±0.08),H=4.168 P<0.05]、Cho/Cr[(1.46±0.19)and(1.32±0.11),H=4.038 P<0.05]、NAA/Cho[(0.76±0.10)and(0.75±0.09),H=0.595P=0.552] 、 α-Glx/Cr[(0.16±0.03)and(0.12±0.04),H=3.361 P<0.05] 、 β 、γ-Glx/Cr[(0.53±0.05)and(0.42±0.07),H=4.698 P<0.05];2.Each set of data ROC curves were analyzed and the area under the ROC curve wasmore than 0.8,and the ROC curve was analyzed by multi-factor joint diagnosisThe left globus pallidus were NAA/Cr(AUC=0.871)、Cho/Cr(AUC=0.867)、NAA/Cho(AUC=0.513)、α-Glx/Cr(AUC=0.713)、β、γ-Glx/Cr(AUC=0.864);The left globus pallidus NAA/Cr、Cho/Cr and β、γ-Glx/Cr was analyzed by multivariate diagnostic ROC curve(AUC=0.966).The right globus pallidus were NAA/Cr(AUC=0.837)、Cho/Cr(AUC=0.827)、NAA/Cho(AUC=0.548)、α-Glx/Cr(AUC=0.772)、β、γ-Glx/Cr(AUC=0.880);The right globus pallidus NAA/Cr、Cho/Cr and β、γ-Glx/Cr was analyzed by multivariate diagnostic ROC curve(AUC=0.921).3.Whether there was a rank correlation between the total bilirubin level and theα-Glx/Cr and β、γ-Glx/Cr of 1H-MRS in the experimental groupIt does not have a rank correlation between the left and right sides of the globus pallidus α-Glx/Cr and β、γ-Glx/Cr and total bilirubin.Conclusion:1.Neonatal bilirubin encephalopathy occurred,1H-MRS determination of NAA /Cr、Cho/Cr、α-Glx/Cr and β、γ-Glx/Cr metabolites in patients with bilirubin encephalopathy were higher than the normal group;.2.NAA /Cr、Cho/Cr、α-Glx/Cr and β、γ-Glx/Cr have a high diagnostic value for neonatal bilirubin encephalopathy,and the combined diagnostic value is more accurate;3.The α-Glx/Cr and β、γ-Glx/Cr ratios of the globus pallidus on both sides were not rank correlated with the total bilirubin level. |
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