摘要
目的探讨早产儿生后早期头颅磁共振成像异常表现（脑白质损伤、脑室扩大及脑室出血）与其12月龄时智力及心理运动发育预后的关系。方法2007年3月15日至2011年4月12日，在解放军第二。二医院住院治疗的早产儿122例在出生8～14d行头颅磁共振成像检查。患儿12月龄时成功随访其中的115例，采用智力发育指数和心理运动发育指数评估其神经发育预后，智力发育指数〈70分为智力发育障碍，～84分为边缘障碍，～114分为正常；心理运动发育指数〈70分为心理运动发育障碍，～84分为边缘障碍，～114分为正常。采用方差分析、LSD两两检验及Kruskal—WallisH检验进行统计学分析。结果122例早产儿中男69例，女53例，中位胎龄32周（28～36周），中位出生体重2050g（1270～3110g）。完成随访的¨5例早产儿中，智力发育障碍者24例，边缘障碍32例，另59例正常；心理运动发育障碍者20例，边缘障碍33例，另62例正常。24例智力发育障碍早产儿平均胎龄[（28．7±1．7）周]、出生体重[（1520．1±44．8）g]和1minApgar评分[（5．5±0．8）分]均显著小于智力发育正常的早产儿[n=59，（33．5±2．2）周、（2240．4±47．1）g和（7．1士0．8）分]，而平均机械通气时间显著延长[（20．4±5．8）d与（5．6±2．7）d3，差异均有统计学意义（t分别为2．37、2．49、2．13和2．44，P均〈0．05）。20例心理运动发育障碍早产儿平均胎龄[（27．9±1．4）周]、出生体重[（1515．6±43．7）g]、1minApgar评分[（5．6土0．5）分]均显著小于心理运动发育正常的早产[n=62，（33．2±2．4）周、（2264．3±42．5）g和（7．2±0．6）分]，而平均机械通气时间显著延长[（18．2±4．7）d与（5．3±2．2）d3，差异均有统计学意义（t分别为2．28、2．52、2．09和2．38，P均〈0．05）。13例脑白质重度损伤的患儿中11例发生智力发育障碍，9例发生心理运动发育障碍；11例中／重度脑室扩大的患儿中7例发生智力发育障碍，6例发生心理运动发育障碍。脑白质损伤程度和脑室扩大程度越重，智力发育障碍的发生率越高（H分别为16．23和14．33，P均〈0．05），心理运动发育障碍的发生率也越高（H分别为18．63和12．69，P均〈0．05）。结论脑白质损伤在早产儿中较为常见，早产儿脑白质损伤及脑室扩大程度越重，其智力及心理运动发育预后越差。
Objective To investigate the relationship between early brain menifestation such as white matter damage and ventriculomegaly detected by magnetic resonance imaging（MRI） and adverse neurodevelopmental outcome in preterm infants. Methods From March 15,2007 to April 12,2011, 122 preterm infants accepted MRI examination 8-14 days after birth in Chinese Peoplers Liberation Army 202 Hospital. Totally, 115 preterm infants were followed up at 12 months old and mental development index（MDI） and psychomotor development index （PDI） score were measured. MDI〈70 was as mental dysfunction, -84 as borderline dysfunction and -114 as normal; PDI〈70 was as psychomotor dysfunction, -84 as borderline dysfunction and -114 as normal. The relationship between clinical characteristics of preterm infants, MRI abnormalities and neurodevelopmental outcome were analyzed by analysis of variance, LSD and Kruskal-Wallis H test. Results The 122 premature infants included 69 males and 53 females with the median gestational age of 32 weeks（28-36 weeks） and the median birth weight of 2050 g （1270-3110 g）. In 24 premature infants with mental dysfunction, the average gestational age [ （28.7 ± 1.7 ） weeks3, birth weight I- （ 1520.1 ± 44.8） g] and 1 min Apgar score （5.5± 0.8） were all lower than those in normal infants En = 59, （33.5 ± 2.2） weeks, （2240.4±47.1） g and 7. 1±0.8], while the average mechanical ventilation time was longer [（20.4±5.8） dvs （5.6±2.7） d]（t=2.37,2.49,2.13 and 2. 44,P〈0. 05）. In 20 premature infants with psychomotor dysfunction, the average gestational age [（27.9±.4） weeks], birth weight [（1515. 6±43. 7） g3, 1 min Apgar score （5.6±0.5） were lower than those in normal infants [n=62, （33.2±2.4） weeks, （2264.3±42.5） g and 7.2±0.6], while the mechanical ventilation time was longer2（18.2±4.7） dvs （5.3±2.2） d]（t=2.28,2.52,2.09 and 2.38,P〈0.05）. Among thirteen preterm infants with severe white matter damage, eleven and nine developed mental or psychomotor dysfunction respectively. Among eleven preterm infants with moderate and severe ventriculomegaly, seven and six developed mental or psychomotor dysfunction respectively. The more severe the white matter damage and ventriculomegaly, the higher the incidence of mental （H= 16. 23 and 14.33, P〈0.05） and psychomotor dysfuction （ H = 18.63 and 12.69, P 〈 0.05）. Conclusions White matter damage is common in preterm infants. Prognosis of preterm infants with mental and psychomotor dysfunction is related with the degree of white matter damage and ventriculomegaly.
出处
《中华围产医学杂志》
CAS
北大核心
2013年第5期278-283,共6页
Chinese Journal of Perinatal Medicine
关键词
脑白质病
磁共振成像
认知障碍
精神运动性障碍
婴儿
早产
Leukoencephalopathies
Magnetic resonance imaging
Cognition disorders
Psychomotor disorders
Infant, premature
