颅脑MRI和全身运动质量评估对极早产儿的运动发育结局的预测作用

Roles of qualitative magnetic resonance imaging and general movements assessments for predicting motor development in very preterm infants

目的比较颅脑MRI和全身运动(GMs)质量评估对于极早产儿运动发育结局的预测价值。方法选取68例在临沂市妇女儿童医院新生儿科和康复科就诊和随访的极早产儿作为研究对象,在纠正胎龄足月时进行颅脑MRI检查以评估大脑白质发育情况,纠正月龄1月和3月时进行两次GMs质量评估,纠正月龄12月时通过临床诊断及Gesell发育量表评估明确其运动发育结局,分析3次评估与运动发育结局的相关性,并分析颅脑MRI和GMs质量评估对预测不良发育结局和脑瘫的敏感性、特异性、阳性预测值和阴性预测值。结果颅脑MRI和GMs质量评估与运动发育结局具有相关性,其中颅脑MRI对运动发育结局预测的准确性最高,其特异性为98.1%,但是其敏感性很低(43.8%)。另一方面,GMs质量评估预测运动发育结局的敏感性很高,而其特异性相对较低。此外两种方法对脑瘫的预测敏感性较高。结论神经影像学(MRI)和功能性评估在对于预测极早产儿运动发育结局上有很强的互补作用。

Objective To compare the predictive value of qualitative MRI of brain structure and general movements assessments for motor development outcome in very preterm infants. Methods Totally 68 very preterm infants from Neonatal Department and Rehabilitation Department of Women＆Children′s Health Care Hospital of Linyi were enrolled in this study. And MRI was conducted at children′s term-equivalent age in order to evaluate white matter abnormality （WMA）.Also, general movements were assessed at corrected age of 1 and 3 months. Motor outcome at corrected age of one year old was evaluated by the Gesell Developmental Schedules and the diagnosis of cerebral palsy made by pediatricians. The associations of MRI and GMs assessments with motor developmental outcome were analyzed, and the sensitivity, specificity, positive predictive value and negative predictive value of MRI and GMs assessment for abnormal motor developmental outcome were calculated. Results MRI and GMs assessments were significantly correlated to motor development outcome. MRI demonstrated the great accuracy in predicting motor outcome with specificity of 98.1% and relatively low sensitivity of 43.8%. On the other hand, GMs assessment had the highest sensitivity and relatively low specificity. Conclusions Neuroimaging （MRI） and functional （GMs） assessments play important complementary roles in predicting motor development of very preterm infants.