高胆红素血症患儿早期头颅影像学异常的门诊随访研究

摘要

Objective To evaluate the application of cranial MRI and/or 1H-MRS in diagnosing child outpatients with hyperbilirubinemia through follow-up visits.Methods A total of 100 hyperbilirubinemia child patients underwent cranial MRI and/or 1 H-MRS and abnormal changes were detected.After necessary clinical intervention,they were discharged and follow-up visited regularly.The visits included clinical neurological examination,MRI and/or 1 H-MRS.The required follow-up frequency was once per month for less than six-month-old child patients,once other month for those more than six-month-old,until one-year-old.Results The diagnostic rate of bilirubin brain injury was 57.0％ by MRI,75.0％ by 1 H-MRS and 25.0％ by both at 7-day-old,which were remarkably higher than 12.0％ by clinical bilirubin detection (P ＜ 0.05).The diagnostic rate of bilirubin brain injury was 39.2％ by MRI and 21.6％ by 1 H-MRS at 3-month-old,which were remarkably higher than 21.6％ by clinical bilirubin detection (P ＜ 0.05).However,there was no statistical difference in the diagnostic rate of bilirubin brain injury among these indexes at 1-year -old (P ＞ 0.05).Conclusions Early cranial MRI or 1 H-MRS is sensitive to diagnose bilirubin brain injury.Dynamic imaging examination in follow-up visits is more clinical useful than single examination.%目的 通过对早期头颅MRI和(或)氢质子磁共振频谱(1H-MRS)诊断异常的高胆红素血症患儿进行门诊随访,评估头颅MRI和1 H-MRS在高胆红素血症临床诊断中的价值.方法 100例高胆红素血症患儿行头颅MRI和或1H-MRS检查,结果异常.给予必要的临床干预后出院,并按时门诊随访.随访内容包括临床神经检查、头颅MRI和或1H-MRS等.月龄小于6个月者,每月随访1次,月龄大于或等于6个月以上者,每2个月随访1次,随访到1岁.结果 7日龄时单项MRI、单项1H-MRS、MRI和1H-MRS均异常的胆红素脑损伤诊断率分别是57.0％、75.0％和25.0％,显著高于临床胆红素脑损伤诊断率12.0％(P＜0.05).3月龄时单项MRI、单项1H-MRS的胆红素脑损伤诊断率均为39.2％,显著高于临床胆红素脑损伤诊断率21.6％ (P ＜0.05).1岁时,各指标对胆红素脑损伤的诊断率相比,差异无统计学意义(P＞0.05).结论 早期头颅MRI或1H-MRS对胆红素脑损伤的诊断较敏感,动态随访患儿MRI检查比单次检查更有临床意义.