早期应用重组人促红细胞生成素对早产儿脑白质发育的影响

Effect of early application of recombinant human erythropoietin on white matter development in preterm infants

目的应用磁共振弥散张量成像(DTI)的部分各项异性参数(FA)评价早期应用重组人促红细胞生成素(rhEPO)对早产儿脑白质发育的影响。方法以81例胎龄≤32周、出生体重<1 500 g、生后24 h内住院的早产儿为研究对象,随机分为两组:rhEPO组(42例)使用rhEPO治疗,对照组(39例)使用等体积的生理盐水注射。2组均于纠正胎龄35~37周行头部MRI、DWI、DTI检查,并测定相同感兴趣区的部分各项异性参数(FA)。结果两组早产儿颅内出血、脑室周围白质软化、局灶性脑白质损伤、广泛性脑白质损伤等发生率的差异无统计学意义(P>0.05)。rhEPO组早产儿内囊后肢、胼胝体压部、额叶白质、枕叶白质FA值高于对照组(P<0.05),2组早产儿顶叶白质、丘脑、豆状核、尾状核FA值的差异无统计学意义(P>0.05)。结论早期应用重组人红细胞生成素对早产儿脑白质发育有神经保护作用。

Objective To evaluate the effect of early application of recombinant human erythropoietin（rhEPO） on white matter development in preterm infants using fractional anisotropy（FA） of magnetic resonance diffusion tensor imaging（DTI）. Methods A total of 81 preterm infants with gestational age ≤32 weeks, birth weight 1 500 g, and hospitalization within 24 hours after birth were randomly divided into rhEPO group（42 infants） and control group（39 infants）. The infants in the rh EPO group were administered rhEPO, while those in the control group were given the same volume of normal saline. The preterm infants of both groups took examinations of head magnetic resonance imaging, diffusion-weighted imaging, and DTI at the corrected gestational age of 35-37 weeks. FA was calculated for the regions of interest in both groups. Results There was no significant difference in the incidence of intracranial hemorrhage, periventricular leukomalacia, focal cerebral white matter damage（CWMD）, and extensive CWMD between rhEPO and control groups（P〉0.05）. Compared with the control group, the rhEPO group showed higher FA values at the posterior limb of the internal capsule, the splenium of the corpus callosum, frontal white matter, and occipital white matter（P〈0.05）. There was no significant difference in FA values at the parietal white matter, thalamus, lenticular nucleus, and caudate nucleus between the two groups（P〉0.05）. Conclusions Early application of rhEPO has a neuroprotective effect on white matter development in preterm infants.