脑室周围白质软化症患儿发生脑瘫的高危风险个体化预测

Individualized prediction of high risk of cerebral palsy in children with periventricular leukomalacia

目的探索脑室周围白质软化症(PVL)患儿发生脑瘫(CP)的相关危险因素,为临床早期个体化筛查CP高危儿及早期干预提供依据及参考,降低CP的发病率。方法纳入2014-02—2018-03河南中医药大学第一附属医院经颅脑磁共振诊断为PVL的114例入院患儿为研究对象,根据CP的诊断分为CP组及非CP组,回顾性分析临床资料,采用多因素Logistic回归模型评估CP发生的独立预测因素。结果114例PVL患儿发生CP 87例,发生率为76.3%。单因素分析显示,2组间性别、早产、低体质量、缺血缺氧性脑病(HIE)、新生儿期颅内出血、母孕期糖尿病、胎膜早破、母孕期上呼吸道感染差异有统计学意义(P<0.15)。多因素Logistic回归分析显示,早产(OR=1.34,95%CI 1.47~9.94),HIE(OR=1.03,95%CI 1.02~7.67),母孕期上呼吸道感染(OR=2.08,95%CI 0.97~66.83),是CP的独立预测因素(P<0.05)。结论早产、HIE、母孕期上呼吸道感染是PVL发生CP的独立危险因素,本研究可实现个体化预测PVL发生CP的风险,早期识别及早期干预高危患儿,降低CP的发生率。

Objective To explore the risk factors of cerebral palsy(CP)in children with periventricular leukomalacia,and to provide evidence and reference for early individualized screening of high-risk children with cerebral palsy and early intervention,reduce the incidence of CP.Methods Between February 2014 and March 2018,144 PVL children diagnosed by magnetic resonance in the First Affiliated Hospital of Henan University of Chinese Medicine were retrospectively enrolled.According to the CP diagnosis results of follow-up,they were divided into CP group and non-CP group.Their clinical data were retrospectively analyzed.Univariate and multivariate logistic regression was used to explore the independent risk factors of CP.Results There were 87 cases of 114 children has CP,the incidence was 76.3%.Univariate analysis showed that sex,premature birth,low body weight,ischemic and hypoxic encephalopathy(HIE),neonatal intracranial hemorrhage,maternal diabetes mellitus,premature rupture of membranes,upper respiratory tract infection during pregnancy had statistical differences between the two groups(P<0.15).Multivariate logistic regression analysis showed that preterm birth(OR=1.34,95%CI 1.47-9.94),ischemic-hypoxic encephalopathy(OR=1.03,95%CI 1.02-7.67),upper respiratory tract infection during pregnancy(OR=2.08,95%CI 0.97-66.83)were independent predictors of PVL with CP.Conclusion This study can individually predict the risk of PVL with CP,early identify high-risk children and intervention to reduce the incidence of CP.