脑损伤早产儿影像学改变与神经发育预后相关性研究

Study on the Correlation between Imaging Changes and Neurodevelopmental Prognosis in Premature Infants with Brain Injury

目的:探讨脑损伤早产儿影像学改变与神经发育预后的相关性,为临床预测脑损伤早产儿神经发育预后提供依据。方法:选择2014年5月~2015年9月于某院小儿神经康复科就诊,且在纠正胎龄后1个月~3个月时经外院颅部磁共振成像(Magnetic resonance imaging,MRI)确定为脑损伤的早产儿50例,根据MRI结果,统计早产儿的脑损伤类型。对脑损伤早产儿实施康复治疗,并对其进行持续24个月的跟踪随访,每隔6个月采用Gesell量表评估其神经发育状况,比较不同脑损伤影像学改变类型早产儿的DQ评分。结果:(1)50例脑损伤早产儿中,有脑白质发育不良18例、脑实质出血3例、脑室周围白质软化10例、蛛网膜下腔增宽7例、缺氧缺血性脑病9例、多发性脑软化3例;(2)干预前,脑白质发育不良组、脑室周围白质软化组、缺氧缺血性脑病组、蛛网膜下腔增宽组的各维度DQ评分比较,差异均无统计学意义(P>0.05);各组干预后的各维度DQ评分均较干预前增高(P<0.05);干预6个月、12个月、18个月、24个月后,各组在各个维度的DQ评分比较均有统计学差异(P<0.05),从高至低依次排列为缺氧缺血性脑病组、蛛网膜下腔增宽组、脑白质发育不良组、脑室周围白质软化组。结论:脑损伤早产儿不同的头颅影像学改变其神经发育预后不同,临床上可根据脑损伤早产儿的头颅影像学改变预测其神经发育预后。

Objective:To investigate the correlation between imaging changes and neurodevelopmental prognosis in premature infants with brain injury,and to provide evidence for clinical prediction of neurodevelopmental prognosis in premature infants with brain injury.Methods:50 premature infants with brain injury diagnosed by magnetic resonance imaging(MRI)from 1 month to 3 months after correcting gestational age from May 2014 to September 2015 were selected.According to the results of MRI,the types of brain injury in premature infants were counted.The premature infants with brain injury were treated with rehabilitation and followed up for 24 months.The neurodevelopmental status was assessed by Gesell scale every 6 months.The DQ scores of premature infants with different brain injury imaging changes were compared.Results:(1)Among the 50 premature infants with brain injury,there were 18 cases of leukodystrophy,3 cases of cerebral parenchymal hemorrhage,10 cases of periventricular leukomalacia,7 cases of subarachnoid enlargement,9 cases of hypoxic-ischemic encephalopathy and 3 cases of multiple encephalomalacia;(2)Before intervention,there was no significant difference in the DQ scores of each dimension among the white matter dysplasia group,periventricular leukomalacia group,hypoxic-ischemic encephalopathy group and subarachnoid enlargement group(P>0.05);After intervention,the DQ scores of each dimension in each group were higher than those before intervention(P<0.05);After intervention for 6 months,12 months,18 months and 24 months,the DQ scores of each dimension in each group were higher than those before intervention(P<0.05),with statistical differences in the scores.The order from high to low was hypoxic-ischemic encephalopathy group,subarachnoid enlargement group,white matter dysplasia group and periventricular leukomalacia group.Conclusion:Different cranial imaging changes of premature infants with brain injury have different neurodevelopmental prognosis,which can be predicted clinically according to cranial imaging changes of premature infants with brain injury.