33例早产儿脑白质损伤的临床及MRI特征分析

目的探讨早产儿脑白质损伤(特别是脑室周围白质软化,PVL)的临床特点与核磁共振(MRI)表现。方法对2003年10月～2008年10月我院新生儿重症监护病房(NICU)收治的33例早产儿脑白质损伤患儿的临床资料进行回顾性分析。结果本组患儿新生儿期临床表现无明显特异性,后期可出现脑瘫、皮质盲、智力低下、癫痫等后遗症,与MRI晚期表现有较大相关性。参照Flodmark之MRI诊断标准,符合PVL20例(其中轻度15例,中度3例,重度2例),脑室旁白质持续病变5例,一过性病变8例。重症病例的发生与颅内出血伴脑室扩大密切相关。结论早产儿脑白质损伤可导致严重后遗症,尤重度PVL预后不良。注意预防并及时处理引起危重早产儿供氧供血障碍的因素,有望可减少PVL的发生。MRI对PVL晚期具有特征性表现,较适合后期随访及评估。

Objective To study the clinical and MRI （magnetic resonance imaging） characteristics of 33 premature infants with white matter injury （especially periventricular leukomalaeia, PVL）. Methods Retrospectively analyzed the clinical data of 33 premature infants with white matter injury treated in our hospital neonatal intensive care unit （NICU） from October 2003 to October 2008. Results In these 33 cases,no specific clinical manifestations in neonatal period, but latter sequela appeared,such as cerebral palsy, cortical blindness, mental retardation, epilepsy and so on, which had more relevance with advanced performance in MRI. According to the MRI diagnostic criteria of Flodmark 20 cases were PVL （of which 15 cases of mild, moderate, three cases, two cases of severe）, 5 cases were periventricular white matter continuous affection, 8 cases had transient affection. The occurrence of severe cases were closely related with the intracranial hemorrhage and expansion of ventricle. Conclusion White matter injury in premature infants can cause serious side effects, particularly poor prognosis of severe PVL. Attention to the prevention and timely to deal with blood oxygen barrier factors which cause critically illness in premature infants, so it is expected to reduce the incidence of PVL. MRI of the late PVL has a characteristic performance, more suitable for the late follow-up and assessment.