脑室周围白质软化症合并脑瘫患儿的磁共振征象与智能的相关性分析

Correlation analysis of magnetic resonance features and intelligence in periventricular leukomalacia children with cerebral palsy

目的分析脑室周围白质软化症(PVL)合并脑性瘫痪(CP)患儿的磁共振(MRI)征象与智能的相关性,探讨颅脑结构与功能的关系,为临床决策及早期康复提供科学依据。方法纳入2013-10—2019-07于河南中医药大学第一附属医院诊治的PVL合并CP的患儿45例,所有患儿行颅脑MRI检查,并在检查前后1周内行Gesell智力评估及粗大运动功能测试。回顾性分析患儿的临床基线资料(磁共振检查时年龄、性别、胎龄、体质量)及MRI征象(脑白质损伤,白质体积减少,白质囊变,侧脑室扩张,侧脑壁不整,胼胝体变薄,灰质损伤),采用searperman相关性分析分别评估CP分型、粗大运动功能分级(GMFCS)、磁共振征象与智能的相关性。结果45例CP患儿中均存在智能障碍。CP分型与智能障碍程度呈正相关(r=0.580,P<0.05);GMFCS与智能障碍程度呈正相关(r=0.597,P<0.05);磁共振征象中,侧脑室体部白质损伤(r=0.310,P<0.05),半卵圆中心白质体积减少(r=0.318,P<0.05),中央皮质损伤(r=0.294,P<0.05)这三个部位的异常与智力障碍的程度呈正相关。结论CP患儿的智能障碍程度不仅与CP分型及GMFCS正相关,而且也与损伤的解剖部位正相关,损伤越重,智力障碍越严重,基于以上征象有助于早期评估预后及进行针对性康复治疗。

Objective To analyze the correlation between magnetic resonance signs and intelligence in periventricular leukomalacia(PVL)children with cerebral palsy(CP),investigate the relationship between craniocerebral structure and function to provide scientific basis for clinical decision-making and early rehabilitation.Methods From October 2013 to July 2019,45 PVL children with CP diagnosed by the First Affiliated Hospital of Henan University of Traditional Chinese Medicine were enrolled.All children underwent MRI,Gesell intelligence and gross motor function assessment were performed within one week before and after the MRI examination.The clinical baseline data(age at MR examination,sex,gestational age,birth weight)and MRI features(white matter injury,white matter volume reduction,white matter cyst degeneration,lateral ventricle dilatation,lateral wall irregularity,thinning of corpus callosum,gray matter injury)were retrospectively analyzed.Results Mental retardation were found in 45 children with CP.CP typing(r=0.580,P<0.05)and GMFCS(r=0.597,P<0.05)was positively correlated with the severity of intellectual impairment,respectively;among PVL-associated MR features,abnormality in the body of lateral ventricle(r=0.310,P<0.05),white matter volume reduction of centrum semiovale(r=0.318,P<0.05)and the abnormality in central cortex(r=0.294,P<0.05)were positively correlated with the degree of intellectual impairment.Conclusion The degree of intellectual impairment in PVL children with CP is positively correlated not only with CP typing and GMFCS,but also with the anatomical site of the injury.The injury more severe,the intellectual impairment is more serious.Based on the above features which is helpful to evaluate the prognosis early and carry out targeted rehabilitation treatment.