18-氟脱氧葡萄糖正电子发射断层/CT及振幅整合脑电图评价亚低温治疗新生儿胆红素脑病的疗效

doi:10.3969/j.issn.1006-9771.2017.06.015

《中国康复理论与实践》 ›› 2017, Vol. 23 ›› Issue (6): 690-695.doi: 10.3969/j.issn.1006-9771.2017.06.015

18-氟脱氧葡萄糖正电子发射断层/CT及振幅整合脑电图评价亚低温治疗新生儿胆红素脑病的疗效

颜云, 李清平, 董文斌, 贾雯, 郭琳, 翟雪松, 康兰

西南医科大学附属医院新生儿科,四川泸州市 646000。

收稿日期:2016-08-25 修回日期:2016-12-08 出版日期:2017-06-25 发布日期:2017-06-27
通讯作者: 李清平(1958-),男,汉族,四川泸州市人,硕士,主任医师,教授,硕士研究生导师,主要研究方向：新生儿疾病。E-mail: lzlqp@126.com。
作者简介:颜云(1988-),女,汉族,贵州贵阳市人,硕士,医师,主要研究方向：新生儿脑病。

Effect of Mild Hypothermia Therapy on Neonatal Bilirubin Encephalopathy: Evaluated with ¹⁸F-fluorodeoxyglucose Positron Emission Tomography/CT and Amplitude Integrated Electroencephalogram

YAN Yun, LI Qing-ping, DONG Wen-bin, JIA Wen, GUO Lin, ZHAI Xue-song, KANG Lan

First Department of Neonatology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China

Received:2016-08-25 Revised:2016-12-08 Published:2017-06-25 Online:2017-06-27
Contact: Correspondence to LI Qing-ping. E-mail: lzlqp@126.com

摘要/Abstract

摘要： 目的探讨亚低温治疗新生儿胆红素脑病的临床疗效及18-氟脱氧葡萄糖(¹⁸F-FDG)正电子发射断层(PET)/CT和振幅整合脑电图(aEEG)的诊断和疗效判断价值。方法 2013年5月至2014年12月,29例胆红素脑病患儿分为常规组(n=15)和亚低温组(n=14)。常规组采用常规治疗,亚低温组加用选择性头部亚低温治疗。观察两组患儿治疗前后aEEG、神经烯醇化酶(NSE)及治疗后的¹⁸F-FDG PET/CT脑葡萄糖代谢率。结果两组NSE治疗后均显著降低(t>9.670, P<0.001),亚低温组治疗后NSE显著低于常规组(F=46.146, P<0.001)。两组治疗后aEEG的睡眠觉醒周期(SWC)、癫痫样活动及异常程度均有改善(P<0.05),亚低温组治疗后的SWC、癫痫样活动及异常程度恢复更好(P<0.05)。亚低温组治疗后各脑区脑葡萄糖代谢改善明显优于常规组(Z>2.943, P<0.01)。脑葡萄糖代谢率与aEEG及NSE改变呈负相关(r>0.640, P<0.05)。结论亚低温治疗新生儿急性胆红素脑病,可更好地促进脑细胞能量代谢恢复;¹⁸F-FDG PET/CT和aEEG可用于胆红素脑病的早期诊断及疗效判断,具有一定临床价值。

关键词: 新生儿, 胆红素脑病, 亚低温, 18-氟脱氧葡萄糖正电子发射断层/CT, 振幅整合脑电图, 葡萄糖代谢, 神经烯醇化酶

Abstract: Objective To investigate the clinical effect of mild hypothermia on neonatal bilirubin encephalopathy, and the value of ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET)/CT and amplitude integrated electroencephalogram (aEEG) for diagnosis and evaluation of curative effect. Methods From May, 2013 to December, 2014, 29 newborns with bilirubin encephalopathy were divided into conventional group (n=15) and mild hypothermia group (n=14). The conventional group received conventional therapy, and the other group received mild hypothermia in addition. The aEEG and neuron-specific enolase (NSE) were measured before and after treatment, as well as the glucose metabolism rate with ¹⁸F-FDG PET/CT after treatment. Results The NSE was lower after treatment in both groups (t>9.670, P<0.001), and was lower in the mild hypothermia group than in the conventional group (F=46.146, P<0.001). After treatment, sleep-wake cycle (SWC), epileptiform activity and the degree of abnormality were obviously improved (P<0.05), and were better in the mild hypothermia group than in the conventional group (P<0.05). The cerebral glucose metabolism rate was significantly better in the mild hypothermia group than in the conventional group (t>2.943, P<0.01). The cerebral glucose metabolism rate was negatively correlated with aEEG and NSE (r>0.640, P<0.05). Conclusion Mild hypothermia therapy could further promote the energy metabolism of brain cells in neonatal bilirubin encephalopathy. ¹⁸F-FDG PET/CT and aEEG can be used for early diagnosis and therapeutic evaluation.

Key words: newborn, bilirubin encephalopathy, mild hypothermia, 18F-fluorodeoxyglucose positron emission tomography/CT, amplitude integrated electroencephalography, glucose metabolism, neuron-specific enolase

中图分类号:

R722.1

颜云, 李清平, 董文斌, 贾雯, 郭琳, 翟雪松, 康兰. 18-氟脱氧葡萄糖正电子发射断层/CT及振幅整合脑电图评价亚低温治疗新生儿胆红素脑病的疗效[J]. 《中国康复理论与实践》, 2017, 23(6): 690-695.

YAN Yun, LI Qing-ping, DONG Wen-bin, JIA Wen, GUO Lin, ZHAI Xue-song, KANG Lan. Effect of Mild Hypothermia Therapy on Neonatal Bilirubin Encephalopathy: Evaluated with ¹⁸F-fluorodeoxyglucose Positron Emission Tomography/CT and Amplitude Integrated Electroencephalogram[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2017, 23(6): 690-695.

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18-氟脱氧葡萄糖正电子发射断层/CT及振幅整合脑电图评价亚低温治疗新生儿胆红素脑病的疗效

Effect of Mild Hypothermia Therapy on Neonatal Bilirubin Encephalopathy: Evaluated with ¹⁸F-fluorodeoxyglucose Positron Emission Tomography/CT and Amplitude Integrated Electroencephalogram

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18-氟脱氧葡萄糖正电子发射断层/CT及振幅整合脑电图评价亚低温治疗新生儿胆红素脑病的疗效

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Effect of Mild Hypothermia Therapy on Neonatal Bilirubin Encephalopathy: Evaluated with ¹⁸F-fluorodeoxyglucose Positron Emission Tomography/CT and Amplitude Integrated Electroencephalogram