Mercuri E, Rutherford M, Barnett A, Foglia Chr, Haataja L, Counsell S, Cowan F, Dubowitz L
Department of Paediatrics; Imperial College School of Medicine, Hammersmith Campus, London, United Kindom.
Neuropediatrics. 2002 Jun;33(3):150-6. doi: 10.1055/s-2002-33412.
The aim of this study was to establish whether, in full-term infants presenting with neonatal encephalopathy, the 1 minute Apgar score gives an indication of the presence, site or type of lesions observed on brain MRI in the neonatal period.
The study cohort included 157 full-term infants who had neurological abnormalities during the first 48 hours after delivery. Infants with developmental, genetic, infective or metabolic diagnoses were excluded from the study. The infants were subdivided according to their 1 minute Apgar score into three groups as follows: Apgar score 0 - 3 (n = 108/157, 69 %), 4 - 7 (n = 29, 19 %), 8 - 10 (n = 21, 12 %). Results. Severe and moderate basal ganglia and thalamic (BGT) lesions, with one exception, were only observed in the group with an Apgar score of 3 or below. Minimal BGT lesions were, with one exception, associated with scores below 7 and mainly below 3. However, not all the infants with low Apgar scores had BGT lesions and 28 % of the patients with Apgar scores below 3 had normal scans or only minimal white matter changes. White matter lesions without BGT involvement were equally distributed in the cohort, irrespective of the Apgar scores. Cerebral infarction and scattered white matter haemorrhages were the most common findings in infants with Apgar scores of 4 and above. The Apgar scores were not always predictive of motor outcome at 2 years but the presence and severity of the sequelae mainly reflected the site and severity of MRI findings.
These findings stress the importance of subdividing neonatal encephalopathy into diagnostic categories according to brain lesions if one wishes to study either causative factors or outcome.
本研究旨在确定，对于患有新生儿脑病的足月儿，1分钟阿氏评分是否能提示新生儿期脑磁共振成像（MRI）所观察到的病变的存在、部位或类型。
研究队列包括157名在出生后48小时内出现神经功能异常的足月儿。患有发育、遗传、感染或代谢性疾病诊断的婴儿被排除在研究之外。根据1分钟阿氏评分将婴儿分为以下三组：阿氏评分0 - 3分（n = 108/157，69%），4 - 7分（n = 29，19%），8 - 10分（n = 21，12%）。结果。除1例例外，严重和中度基底神经节和丘脑（BGT）病变仅在阿氏评分为3分及以下的组中观察到。除1例例外，最小的BGT病变与评分低于7分相关，主要是低于3分。然而，并非所有阿氏评分低的婴儿都有BGT病变，28%阿氏评分低于3分的患者扫描结果正常或仅有轻微的白质改变。无BGT受累的白质病变在队列中分布均匀，与阿氏评分无关。脑梗死和散在的白质出血是阿氏评分4分及以上婴儿中最常见的发现。阿氏评分并不总是能预测2岁时的运动结局，但后遗症的存在和严重程度主要反映了MRI检查结果的部位和严重程度。
这些发现强调，如果想研究病因或结局，将新生儿脑病根据脑病变分为不同诊断类别具有重要意义。
