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中华脑科疾病与康复杂志(电子版)

中华脑科疾病与康复杂志(电子版) ›› 2020, Vol. 10 ›› Issue (01) : 11 -15. doi: 10.3877/cma.j.issn.2095-123X.2020.01.003

所属专题： 专题评论； 文献；

临床研究

氢质子核磁波谱对儿童热性惊厥脑异常检出和预后评估的价值分析
曹建伟1,†(), 刘美玲1, 李莹莹1, 郑铠军1, 杨昂1, 卢贤秀1   
  1. 1. 528400　中山市人民医院普通儿科
  • 收稿日期:2020-07-10 出版日期:2020-02-15
  • 通信作者: 曹建伟
  • 基金资助:
    中山市社会公益科技研究项目(2019B1018)

Analysis of the value of hydrogen proton nuclear magnetic spectrum in detection of cerebral parenchymal abnormalities and evaluation of the prognosis in febrile seizures child

Jianwei Cao1,†(), Meiling Liu1, Yingying Li1, Kaijun Zheng1, Ang Yang1, Xianxiu Lu1   

  1. 1. Department of General Pediatrics, Zhongshan City People Hospital, Zhongshan 528400, China
  • Received:2020-07-10 Published:2020-02-15
  • Corresponding author: Jianwei Cao
  • About author:
    Corresponding author: Cao Jianwei, Email:
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引用本文：

曹建伟, 刘美玲, 李莹莹, 郑铠军, 杨昂, 卢贤秀. 氢质子核磁波谱对儿童热性惊厥脑异常检出和预后评估的价值分析[J]. 中华脑科疾病与康复杂志(电子版), 2020, 10(01): 11-15.

Jianwei Cao, Meiling Liu, Yingying Li, Kaijun Zheng, Ang Yang, Xianxiu Lu. Analysis of the value of hydrogen proton nuclear magnetic spectrum in detection of cerebral parenchymal abnormalities and evaluation of the prognosis in febrile seizures child[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2020, 10(01): 11-15.

目的

探讨氢质子核磁波谱（H1-MRS）检查对儿童热性惊厥（FS）的脑实质异常的检测效率，及其用于预测临床预后的价值。

方法

选择中山市人民医院普通儿科自2017年3月至2018年5月收治的38例FS患儿作为研究对象，所有患儿均进行颅脑MRI及H1-MRS检查，比较MRI和H1-MRS检查对FS患儿颅内异常检出效率差异。根据H1-MRS结果计算代谢物质氮-乙酰天门冬氨酸（NAA）/[肌酸（Cr）+磷酸肌酸（Cho）]、NAA/Cr、NAA/Cho值，然后根据患儿出现临床不良预后情况分为有不良临床预后组和无不良临床预后组，比较2组患儿间NAA/（Cr+Cho）、NAA/Cr、NAA/Cho值差异，并分析其对预后的评估价值。

结果

38例FS患儿中，MRI检出颅脑异常情况有23例，H1-MRS检出颅脑异常情况有32例，异常情况检出率比较差异具有统计学意义（χ2=5.330，P=0.021）。13例FS患儿出现不良临床预后，有不良临床预后组患儿中表现为复杂型的比率高于无不良临床预后组，差异有统计学意义（P<0.05）。有不良临床预后组患儿的NAA/（Cr+Cho）、NAA/Cr、NAA/Cho值均小于无不良临床预后组，差异有统计学意义（P<0.05）。绘制NAA/（Cr+Cho）、NAA/Cr、NAA/Cho值对预测不良临床预后ROC曲线，其相应的曲线下面积分别为0.848、0.774、0.797。

结论

H1-MRS检查对FS患儿脑实质异常的检出率高于MRI检查，且H1-MRS结果计算所得的NAA/（Cr+Cho）、NAA/Cr、NAA/Cho值在FS患儿中显著降低，其中，NAA/（Cr+Cho）值对患儿的预后具有较好的预测价值。

关键词: 热性惊厥, 核磁共振, 氢质子核磁波谱, 儿童
Objective

To investigate the efficiency of hydrogen proton nuclear magnetic resonance spectroscopy (H1-MRS) in detection of cerebral parenchymal abnormalities, and the predict the value of clinical prognosis in children with febrile seizures (FS).

Methods

Thirty-eight children with FS given treatments from March 2017 to May 2018 in general pediatrics department of Zhongshan City People Hospital were selected as research objects. All children were examined by brain MRI and H1-MRS, and the values of the metabolites N-acetylaspartic acid/(creatine+Creatine phosphate) [NAA/(Cr+Cho)], NAA/Cr and NAA/Cho were calculated according to the results of H1-MRS. Then, the differences in NAA/(Cr+Cho), NAA/Cr and NAA/Cho values between the children with and without poor clinical prognosis were compared according to the clinical poor prognosis of the children. The prognostic value of NAA/(Cr+Cho), NAA/Cr and NAA/Cho values were analyzed.

Results

Among the 38 children with FS, 23 craniocerebral abnormalities cases were detected by MRI and 32 craniocerebral abnormalities cases were detected by H1-MRS, there was a statistically difference (χ2=5.330, P=0.021). Of the 38 children with FS, 13 had poor clinical prognosis and 25 had no poor clinical prognosis, the rate of complex type in the group with poor clinical prognosis was higher than that in the group without poor clinical prognosis, and there was a statistically difference (P<0.05). NAA/(Cr+Cho), NAA/Cr and NAA/Cho in the group with poor clinical prognosis were all lower than those in the group without poor clinical prognosis, showing statistically significant differences (P<0.05). The ROC curve of NAA/(Cr+Cho), NAA/Cr and NAA/Cho for predicting poor clinical prognosis was drawn, and the corresponding area under the curve (ACU) was 0.848, 0.774 and 0.797, respectively.

Conclusion

The detection rate of brain parenchymal abnormalities by H1-MRS examination was higher than that by MRI examination, and the NAA/(Cr+Cho), NAA/Cr and NAA/Cho values calculated by H1-MRS results were significantly reduced in children with thermal convulsion. Among them, NAA/(Cr+Cho) values were of good predictive value for the prognosis of the children.

Key words: Febrile seizures, Magnetic resonance, Hydrogen proton nuclear magnetic resonance spectroscopy, Children
图1 MRI与H1-MRS对脑实质异常检出的差异示例
表1 患儿的基本情况及代谢物质比较
项目 有不良临床预后组(n=13) 无不良临床预后组(n=25) χ2/t值 P值
性别（男/女） 6/7 15/10 0.663 0.415
年龄（岁） 3.22±1.16 2.61±1.01 1.682 0.101
临床类型（复杂/简单） 9/4 8/17 4.795 0.029
NAA/(Cr+Cho) 0.57±0.11 0.67±0.11 2.712 0.010
NAA/Cr 1.36±0.18 1.50±0.19 2.313 0.027
NAA/Cho 0.96±0.24 1.22±0.31 2.854 0.008
图2 NAA/（Cr+Cho）、NAA/Cr、NAA/Cho值对不良预后预测的ROC曲线
表2 NAA/（Cr+Cho）、NAA/Cr、NAA/Cho值对预后的预测价值
测试因素 曲线下面积 SD P值 95%CI
NAA/(Cr+Cho) 0.848 0.063 <0.001 0.725~0.971
NAA/Cr 0.774 0.084 0.005 0.610~0.938
NAA/Cho 0.797 0.078 0.002 0.643~0.951
[1]
Emsley HCA, Appleton RE, Whitmore CL, et al. Variations in inflammation-related genes may be associated with childhood febrile seizure susceptibility[J]. Seizure, 2014, 23(6): 457-461.
[2]
王怡，董晓峰，程庆璋.热性惊厥儿童的脑电图异常与后期癫痫发生率[J].微循环学杂志, 2015, 25(1): 55-58.
[3]
Chan S, Bello JA, Shinnar S, et al. Hippocampal malrotation is associated with prolonged febrile seizures: results of the FEBSTAT study[J]. AJR Am J Roentgenol, 2015, 205(5): 1068-1074.
[4]
洪居陆，李慧，冯红梅,等.头颅CT/MRI在热性惊厥诊疗中的应用[J].中国现代医学杂志, 2018, 28(2): 61-64.
[5]
马学梅.热性惊厥患儿颅脑磁共振检查的合理应用[J].中国中西医结合儿科学, 2016, 8(1): 29-31.
[6]
赖顺凯，钟舒明，赵辉,等.双相障碍抑郁期与缓解期患者豆状核磁共振氢质子波谱研究[J].中华精神科杂志, 2017, 50(1): 61-66.
[7]
Zhang F, Wu H, Zhang X. Proton magnetic resonance spectroscopy (H1-MRS) study of the ketogenic diet on repetitive mild traumatic injury in adolescent rats and its effect on neurodegeneration[J]. World Neurosurg, 2018, 120: e1193-e1202.
[8]
刘学军，马海川，李光.磁共振波谱与磁共振成像对原发性癫痫患者海马病变的诊断价值比较[J].中国基层医药, 2015, 22(14): 2111-2114.
[9]
何慧瑾，沈天真，陈星荣,等.磁共振成像和质子磁共振波谱对颞叶癫痫患者手术预后的评价作用[J].中华医学杂志, 2003, 83(18): 1586-1591.
[10]
程晓娟.氢质子核磁共振波谱分析在颞叶癫痫中的应用价值[D].苏州:苏州大学, 2004.
[11]
中华医学会儿科学分会神经学组.热性惊厥诊断治疗与管理专家共识(2017实用版)[J].中华实用儿科临床杂志, 2017, 32(18): 1379-1382.
[12]
朱慧芝，张苗苗，张玉玲.热性惊厥研究进展[J].中国医师进修杂志, 2018, 41(8): 764-768.
[13]
黄熠，王晓明.神经胶质细胞在癫痫发病机制中的作用研究进展[J].中国现代医学杂志, 2020, 30(8): 67-69.
[14]
刘建新，唐锋儒，刘勇. Pilocarpine诱导小鼠癫痫持续状态发作后海马神经元的兴奋激活、损伤和死亡[J].中南大学学报(医学版), 2011, 36(11): 1071-1078.
[15]
曹源，梁国标.磁共振波谱在缺血性脑卒中诊断中的应用[J].中华神经外科疾病研究杂志, 2018, 17(1): 92-94.
[16]
Dani KA, Warach S. Metabolic imaging of ischemic stroke: the present and future[J]. AJNR Am J Neuroradiol, 2014, 35(6 Suppl): S37-S43.
[17]
Yu TG, Feng Y, Feng XY, et al. Prognostic factor from MR spectroscopy in rat with astrocytic tumour during radiation therapy[J]. Br J Radiol, 2015, 88(1045): 20140418.
[18]
Mueller SG, Ebel A, Barakos J, et al. Widespread extrahippocampal NAA/(Cr+Cho) abnormalities in TLE with and without mesial temporal sclerosis[J]. J Neurol, 2011, 258(4): 603-612.
[19]
Tan Z, Long X, Tian F, et al. Alterations in brain metabolites in patients with epilepsy with impaired consciousness: a case-control study of interictal multivoxel 1H-MRS findings[J]. AJNR Am J Neuroradiol, 2019, 40(2): 245-252.
[20]
刘如，杨小枫.阳离子-氯离子协同转运体在癫痫发病机制研究及抗癫痫药物研发中的进展[J].中华医学杂志, 2019, 99(23): 1834-1837.
[21]
彭振峰.长程热性惊厥继发颞叶癫痫的研究进展[J]河北医药, 2009, 31(9): 1110-1111.
[22]
余璐，孟珩，杨斌,等.热性惊厥相关癫痫SCN1A基因内含子突变对mRNA剪切的影响及其与临床表型的关系[J]. 2018, 17(8): 757-764.
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