MRI联合GFAP水平预测新生儿脑损伤中的价值

doi:10.19854/j.cnki.1008-2425.2022.03.0009

摘要/Abstract

摘要： 目的探讨分析MRI联合GFAP水平预测新生儿脑损伤中的价值。方法选取我院2019年1月至2020年12月期间收治的120例新生儿脑损伤患儿作为观察组,并选择同期90例出生疑似脑损伤新生儿作为对照组。采用MRI进行颅脑扫描,并采用酶联免疫吸附试验检测血清神经胶质原纤维酸性蛋白(GFAP)水平。比较2组血清GFAP水平,并进行诊断分析,探讨MRI联合GFAP水平预测新生儿脑损伤的价值。结果观察组患儿血清GFAP(2.34±0.56)ng/ml水平显著高于对照组的(0.85±0.24)ng/ml,差异达到统计学意义(P＜0.05)。MRI诊断,观察组120例患儿中阳性103例,阴性17例;对照组90例患儿中阳性21例,阴性69例;观察组MRI诊断阳性率显著高于对照组(χ²=67.818,P=0.000)。血清GFAP诊断,观察组120例患儿中阳性90例,阴性30例;对照组90例患儿中阳性13例,阴性87例;观察组血清GFAP诊断阳性率显著高于对照组( χ²=72.909,P=0.000)。并且, MRI诊断阳性检出率显著高于血清GFAP诊断( 26.598,P=0.010)。联合诊断的敏感性显著优于单一MRI检测(χ²=5.819,P=0.016)、单一血清GFAP检测( χ²=18.824,P=0.000),联合诊断的准确性显著优于单一MRI检测( χ²=6.821,P=0.009)、单一血清GFAP检测( χ²=9.226,P=0.002),而联合诊断特异性差异无统计学意义(P＞0.05)。MRI检查T1WI横断面影像显示双侧苍白球与壳核信号强度值为1.26时,诊断新生儿脑损伤的ROC曲线下面积最大为0.81,此时的敏感性为89.37%,特异性为82.56%,准确性为55.47%;血清GFAP水平以1.82 ng/ml为截断值诊断新生儿脑损伤的ROC曲线下面积最大为0.76,此时的敏感性为83.64%,特异性为91.35%,准确性为78.39%;联合检测诊断新生儿脑损伤的ROC曲线下面积为0.86,此时的敏感性为97.32%,特异性为89.34%,准确性为93.61%。结论 MRI联合GFAP可提高其诊断的敏感性,且准确性较好对新生儿脑损伤具有较好预测价值,可为临床早期脑损伤评估提供参考。

关键词: 磁共振成像, 血清神经胶质原纤维酸性蛋白, 新生儿脑损伤, 诊断价值

Abstract: Objective To evaluate the value of Ingenia 1.5T MRI combined with GFAP level in predicting neonatal brain injury.Methods A total of 120 neonates with neonatal brain injury admitted to our hospital from January 2019 to December 2020 were selected as the observation group,and 90 neonates born at term without brain injury during the same period were selected as the control group.Brain scans were performed using Ingenia 1.5T magnetic resonance imaging,and serum GFAP levels were determined by enzyma-linked immunosorbent assay.The serum GFAP levels of the two groups were compared,and the diagnostic analysis was conducted to explore the value of Ingenia 1.5T MRI combined with Serum glial fibrillary acidic protein(GFAP)level in predicting neonatal brain injury.Results The serum GFAP level of observation group (2.34±0.56) ng/ mL was significantly higher than that of control group (0.85±0.24) ng/ml,and the difference was statistically significant (P＜0.05).Ingenia 1.5T MRI diagnosis showed that 103 of the 120 children in the observation group were positive and 17 were negative.In the control group,there were 21 positive cases and 69 negative cases.The Ingenia 1.5T MRI positive rate in observation group was significantly higher than that in control group (χ²=67.818,P=0.000).In the observation group,90 cases were positive and 30 cases were negative for GFAP.In the control group,there were 13 positive cases and 77 negative cases.The positive rate of serum GFAP in observation group was significantly higher than that in control group (χ²=72.909,P=0.000).Moreover,the Ingenia 1.5T MRI detection rate was significantly higher than serum GFAP diagnosis (26.598,P=0.010).The sensitivity of combined diagnosis was significantly better than Ingenia 1.5t MRI (χ²=5.819,P=0.016),serum GFAP (χ²=18.824,P=0.000),and the accuracy of combined diagnosis was significantly better than Ingenia 1.5t MRI (χ²=6.821,P=0.000).P=0.009),single serum GFAP test (χ²=9.226,P=0.002),while there was no significant difference in specificity of combined diagnosis (P＞0.05).Ingenia 1.5T MRI showed that when the signal intensity value of bilateral globus pallidus and putamen was 1.26,the maximum area under ROC curve was 0.81,with sensitivity of 89.37%,specificity of 82.56%,and accuracy of 55.47%.The maximum area under ROC curve was 0.76 when serum GFAP level was 1.82 ng/mL,and the sensitivity,specificity and accuracy were 83.64%,91.35% and 78.39% respectively.The area under ROC curve of combined detection for the diagnosis of neonatal brain injury was 0.86,and the sensitivity,specificity and accuracy were 97.32%,89.34% and 93.61% respectively.Conclusion Ingenia 1.5T MRI combined with GFAP can improve the sensitivity of the diagnosis,and its good accuracy has good predictive value for neonatal brain injury,which can provide a basis for early clinical evaluation of brain injury.

Key words: Magnetic resonance imaging, Serum glial fibrillary acidic protein, Neonatal brain injury, Diagnostic value

中图分类号:

R651.1⁺1

郝淑娟, 赵颖, 马彤辉. MRI联合GFAP水平预测新生儿脑损伤中的价值[J]. 立体定向和功能性神经外科杂志, 2022, 35(3): 170-174.

Hao Shujuan, Zhao Ying, Ma Tonghui. The value of Ingenia 1.5T MRI combined with GFAP level in predicting neonatal brain injury[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2022, 35(3): 170-174.

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