From the Departments of Neonatology (J.S., K.T.) and Radiology (N.A., M.T., Y.N.), Kanagawa Children's Medical Center, Yokohama, Japan; Department of Molecular Imaging and Theranostics, National Institute of Radiological Sciences 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan (N.A., M.T.); Department of Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan (N.M.); and Research Center for Child Mental Development, Chiba University, Chiba, Japan (M.T.).
Radiology. 2018 Sep;288(3):840-848. doi: 10.1148/radiol.2018172083. Epub 2018 Jun 12.
Purpose To investigate the time-course changes and predictive utility of brain metabolite concentrations in neonatal hypoxic-ischemic encephalopathy (HIE). Materials and Methods Sixty-eight neonates (age, 35-41 gestational weeks) with HIE were admitted to a neonatal intensive care unit between September 2009 and March 2016 and examined by using proton MR spectroscopy at 18-96 hours (n = 25) and 7-14 days (n = 64) after birth (35-43 postmenstrual weeks) to estimate metabolite concentrations in the deep gray matter. Adverse outcome was defined as death or neurodevelopmental impairment at 18-22 months of age. Areas under the receiver operating characteristic curves were calculated to evaluate the prognostic values of metabolites. Results At 18-96 hours, N-acetylaspartate and creatine concentrations were lower, whereas lactate, and glutamate and glutamine (Glx) concentrations were higher in neonates with adverse outcomes than in those with favorable outcomes. Metabolite concentrations at 18-96 hours decreased during days 7-14 in neonates with adverse outcomes but did not change in those with favorable outcomes. For N-acetylaspartate, creatine, lactate, and Glx concentrations measured at 18-96 hours to predict adverse outcomes, areas under the receiver operating characteristic curve were 0.98, 0.89, 0.96, and 0.88, respectively, whereas at 7-14 days, the areas under the receiver operating characteristic curve were 0.97, 0.97, 0.59, and 0.36, respectively. Conclusion Time-dependent reductions in N-acetylaspartate and creatine concentrations at both 18-96 hours and 7-14 days accurately predicted adverse outcomes. However, higher lactate and glutamate and glutamine concentrations were often transient.
目的 研究新生儿缺氧缺血性脑病（HIE）脑代谢物浓度的时间变化及其预测价值。
材料与方法 2009 年 9 月至 2016 年 3 月期间，68 例胎龄 35-41 周的 HIE 新生儿入住新生儿重症监护病房，在出生后 18-96 小时（n=25）和 7-14 天（n=64）进行质子磁共振波谱检查，以估计深部灰质的代谢物浓度。不良结局定义为 18-22 个月时死亡或神经发育障碍。计算受试者工作特征曲线下面积以评估代谢物的预后价值。
结果 在 18-96 小时时，不良结局新生儿的 N-乙酰天冬氨酸和肌酸浓度较低，而乳酸、谷氨酸和谷氨酰胺（Glx）浓度较高。不良结局新生儿的代谢物浓度在 7-14 天期间下降，但在良好结局新生儿中没有变化。在 18-96 小时测量的 N-乙酰天冬氨酸、肌酸、乳酸和 Glx 浓度用于预测不良结局，受试者工作特征曲线下面积分别为 0.98、0.89、0.96 和 0.88，而在 7-14 天，受试者工作特征曲线下面积分别为 0.97、0.97、0.59 和 0.36。
结论 在 18-96 小时和 7-14 天，N-乙酰天冬氨酸和肌酸浓度的时间依赖性降低准确预测了不良结局。然而，较高的乳酸和谷氨酸和谷氨酰胺浓度往往是短暂的。
