应用于新生儿缺氧缺血性脑病的脑电背景分析新方法

A novel method for electroencephalography background analysis in neonates with hypoxic-ischemic encephalopathy

摘要:

目的 探讨一种新的新生儿缺氧缺血性脑病（hypoxic-ischemic encephaloapthy，HIE）脑电背景评价方法，以及其与临床分度和头部磁共振成像（magnetic resonance imaging，MRI）分度的关系。方法 回顾性分析2016年1月—2022年8月诊断为HIE患儿的出生24 h内视频脑电图（video electroencephalography，vEEG）和同步振幅整合脑电图（amplitude-integrated electroencephalography，aEEG）的监测资料。将脑电背景分析有关项目全部纳入评估系统，按严重程度分层赋分，汇总得到脑电图（electroencephalography，EEG）总分。对EEG总分与头部MRI总分和Sarnat总分（total Sarnat score，TSS；用于评估临床分度）做相关分析。比较不同临床分度组和不同头部MRI分度组间EEG总分是否存在差异。采用受试者工作特征曲线的曲线下面积（area under the curve，AUC）评估EEG总分法对头部MRI中-重度异常和临床中-重度异常的诊断价值，并与aEEG分度法相比较。结果 共收集50例HIE患儿。EEG总分与头部MRI总分、TSS均呈正相关（分别r_s=0.840、0.611，P<0.001）。不同临床分度组和不同头部MRI分度组间EEG总分比较差异均有统计学意义（P<0.05）。EEG总分法和aEEG分度法判断头部MRI中-重度异常的AUC分别为0.936和0.617（P<0.01），判断临床中-重度异常的AUC分别为0.887和0.796（P>0.05）。界定EEG总分≤6分、7~13分、≥14分分别为EEG轻度、中度和重度异常，与临床分度和头部MRI分度一致性最佳（P<0.05）。结论 新的脑电背景评分方法可以定量化反映脑损伤的严重程度，适用于新生儿HIE的脑功能判断。

Abstract:

Objective To explore a new method for electroencephalography (EEG) background analysis in neonates with hypoxic-ischemic encephalopathy (HIE) and its relationship with clinical grading and head magnetic resonance imaging (MRI) grading.Methods A retrospective analysis was performed for the video electroencephalography (vEEG) and amplitude-integrated electroencephalography (aEEG) monitoring data within 24 hours after birth of neonates diagnosed with HIE from January 2016 to August 2022. All items of EEG background analysis were enrolled into an assessment system and were scored according to severity to obtain the total EEG score. The correlations of total EEG score with total MRI score and total Sarnat score (TSS, used to evaluate clinical gradings) were analyzed by Spearman correlation analysis. The total EEG score was compared among the neonates with different clinical gradings and among the neonates with different head MRI gradings. The receiver operating characteristic (ROC) curve and the area under thecurve (AUC) were used to evaluate the value of total EEG score in diagnosing moderate/severe head MRI abnormalities and clinical moderate/severe HIE, which was then compared with the aEEG grading method.Results A total of 50 neonates with HIE were included. The total EEG score was positively correlated with the total head MRI score and TSS (r_s=0.840 and 0.611 respectively, P<0.001). There were significant differences in the total EEG score between different clinical grading groups and different head MRI grading groups (P<0.05). The total EEG score and the aEEG grading method had an AUC of 0.936 and 0.617 respectively in judging moderate/severe head MRI abnormalities (P<0.01) and an AUC of 0.887 and 0.796 respectively in judging clinical moderate/severe HIE (P>0.05). The total EEG scores of ≤6 points, 7-13 points, and ≥14 points were defined as mild, moderate, and severe EEG abnormalities respectively, which had the best consistency with clinical grading and head MRI grading (P<0.05).Conclusions The new EEG background scoring method can quantitatively reflect the severity of brain injury and can be used for the judgment of brain function in neonates with HIE.