Martin E, Buchli R, Ritter S, Schmid R, Largo R H, Boltshauser E, Fanconi S, Duc G, Rumpel H
Division of Magnetic Resonance and Developmental Brain Research, University Children's Hospital, Zurich, Switzerland.
Pediatr Res. 1996 Nov;40(5):749-58. doi: 10.1203/00006450-199611000-00015.
The impact of depressed neonatal cerebral oxidative phosphorylation for diagnosing the severity of perinatal asphyxia was estimated by correlating the concentrations of phosphocreatine (PCr) and ATP as determined by magnetic resonance spectroscopy with the degree of hypoxic-ischemic encephalopathy (HIE) in 23 asphyxiated term neonates. Ten healthy age-matched neonates served as controls. In patients, the mean concentrations +/- SD of PCr and ATP were 0.99 +/- 0.46 mmol/L (1.6 +/- 0.2 mmol/L) and 0.99 +/- 0.35 mmol/L (1.7 +/- 0.2 mmol/L), respectively (normal values in parentheses). [PCr] and [ATP] correlated significantly with the severity of HIE (r = 0.85 and 0.9, respectively, p < 0.001), indicating that the neonatal encephalopathy is the clinical manifestation of a marred brain energy metabolism. Neurodevelopmental outcome was evaluated in 21 children at 3, 9, and 18 mo. Seven infants had multiple impairments, five were moderately handicapped, five had only mild symptoms, and four were normal. There was a significant correlation between the cerebral concentrations of PCr or ATP at birth and outcome (r = 0.8, p < 0.001) and between the degree of neonatal neurologic depression and outcome (r = 0.7). More important, the outcome of neonates with moderate HIE could better be predicted with information from quantitative 31P magnetic resonance spectroscopy than from neurologic examinations. In general, the accuracy of outcome predictability could significantly be increased by adding results from 31P magnetic resonance spectroscopy to the neonatal neurologic score, but not vice versa. No correlation with outcome was found for other perinatal risk factors, including Apgar score.
通过对23例足月窒息新生儿进行磁共振波谱测定磷酸肌酸（PCr）和三磷酸腺苷（ATP）浓度，并将其与缺氧缺血性脑病（HIE）程度相关联，评估新生儿脑氧化磷酸化降低对诊断围产期窒息严重程度的影响。选取10例年龄匹配的健康新生儿作为对照。在患者中，PCr和ATP的平均浓度±标准差分别为0.99±0.46 mmol/L（括号内为正常值1.6±0.2 mmol/L）和0.99±0.35 mmol/L（正常值1.7±0.2 mmol/L）。[PCr]和[ATP]与HIE严重程度显著相关（r分别为0.85和0.9，p<0.001），表明新生儿脑病是脑能量代谢受损的临床表现。对21名儿童在3个月、9个月和18个月时进行神经发育结局评估。7名婴儿有多种损伤，5名中度残疾，5名仅有轻微症状，4名正常。出生时脑内PCr或ATP浓度与结局之间存在显著相关性（r = 0.8，p<0.001），新生儿神经抑制程度与结局之间也存在显著相关性（r = 0.7）。更重要的是，与神经检查相比，定量31P磁共振波谱信息能更好地预测中度HIE新生儿的结局。一般来说，将31P磁共振波谱结果添加到新生儿神经评分中可显著提高结局预测的准确性，但反之则不然。未发现其他围产期危险因素（包括阿氏评分）与结局相关。
