Thorngren-Jerneck K, Ohlsson T, Sandell A, Erlandsson K, Strand S E, Ryding E, Svenningsen N W
Department of Pediatrics, Lund University Hospital, S-221 85 Lund, Sweden.
Pediatr Res. 2001 Apr;49(4):495-501. doi: 10.1203/00006450-200104000-00010.
Total and regional cerebral glucose metabolism (CMRgl) was measured by positron emission tomography with 2-((18)F) fluoro-2-deoxy-D-glucose ((18)FDG) in 20 term infants with hypoxic ischemic encephalopathy (HIE) after perinatal asphyxia. All infants had signs of perinatal distress, and 15 were severely acidotic at birth. Six infants developed mild HIE, twelve moderate HIE, and two severe HIE during their first days of life. The positron emission tomographic scans were performed at 4-24 d of age (median, 11 d). One hour before scanning, 2-3.7 MBq/kg (54-100 microCi/kg) (18)FDG was injected i.v. No sedation was used. Quantification of CMRgl was based on a new method employing the glucose metabolism of the erythrocytes, requiring only one blood sample. In all infants, the most metabolically active brain areas were the deep subcortical parts, thalamus, basal ganglia, and sensorimotor cortex. Frontal, temporal, and parietal cortex were less metabolically active in all infants. Total CMRgl was inversely correlated with the severity of HIE (p < 0.01). Six infants with mild HIE had a mean (range) CMRgl of 55.5 (37.7-100.8) micromol.min(-1).100 g(-1), 11 with moderate HIE had 26.6 (13.0-65.1) micromol.min(-1).100 g(-1), and two with severe HIE had 10.4 and 15.0 micromol.min(-1).100 g(-1), respectively. Five of six infants who developed cerebral palsy had a mean (range) CMRgl of 18.1 (10.2-31.4) micromol.min(-1).100 g(-1) compared with 41.5 (13.0-100.8) micromol.min(-1).100 g(-1) in the infants with no neurologic sequela at 2 y. We conclude that CMRgl measured during the subacute period after perinatal asphyxia in term infants is highly correlated with the severity of HIE and short-term outcome.
采用正电子发射断层扫描技术，以2-（18）氟-2-脱氧-D-葡萄糖（（18）FDG）对20例足月围生期窒息后发生缺氧缺血性脑病（HIE）的婴儿进行全脑及局部脑葡萄糖代谢（CMRgl）测定。所有婴儿均有围生期窘迫体征，15例出生时严重酸中毒。6例婴儿在出生后最初几天发生轻度HIE，12例为中度HIE，2例为重度HIE。正电子发射断层扫描在4至24日龄（中位数为11日）时进行。扫描前1小时，静脉注射2 - 3.7 MBq/kg（54 - 100微居里/千克）（18）FDG。未使用镇静剂。CMRgl的定量基于一种采用红细胞葡萄糖代谢的新方法，仅需采集一份血样。在所有婴儿中，代谢最活跃的脑区为皮质下深部、丘脑、基底神经节和感觉运动皮层。额叶、颞叶和顶叶皮层在所有婴儿中代谢活性较低。总CMRgl与HIE严重程度呈负相关（p < 0.01）。6例轻度HIE婴儿的平均（范围）CMRgl为55.5（37.7 - 100.8）微摩尔·分钟-1·100克-1，11例中度HIE婴儿为26.6（13.0 - 65.1）微摩尔·分钟-1·100克-1，2例重度HIE婴儿分别为10.4和15.0微摩尔·分钟-1·100克-1。6例发生脑性瘫痪的婴儿中，5例的平均（范围）CMRgl为18.1（10.2 - 31.4）微摩尔·分钟-1·100克-1，而2岁时无神经后遗症的婴儿为41.5（13.0 - 100.8）微摩尔·分钟-1·100克-1。我们得出结论，足月婴儿围生期窒息后亚急性期测定的CMRgl与HIE严重程度及短期预后高度相关。
