振幅整合脑电图结合头颅MRI对窒息早产儿脑损伤的诊断及神经行为发育的预测

Amplitude-integrated electroencephalogram combined with cranial magnetic resonance imaging for diagnosis of brain injury and prediction on neurobehavioral development in premature infants with asphyxiation

目的探讨生后6 h、3 d振幅整合脑电图(amplitude-integrated electroencephalogram,aEEG)与磁共振成像(magnetic resonance imaging,MRI)预测窒息早产儿矫正年龄6个月时不良神经行为学发育的价值。方法对2017年12月至2019年6月在本院产科分娩、因窒息转入新生儿病房住院的50例早产儿,出生后6 h内进行aEEG监测,随后1次/d,至少4 h/次,矫正胎龄40周时行头颅MRI检查,矫正年龄6个月时行Gesell发育诊断量表评估婴儿的神经运动发育功能,分为预后良好组及预后不良组。运用SPSS 19.0软件进行统计学分析,采用独立样本t检验与χ^2检验分析2组之间的差异;分析aEEG分级与MRI之间的关系,及它们对矫正年龄6个月时不良神经行为学发育的预测价值。结果不同aEEG的临床分级的早产儿MRI上的脑白质损伤(H=24.896,P<0.01)及颅内出血(H=29.245,P<0.01)程度存在差异。出生后6 h及3 d,aEEG预测不良预后的敏感性分别为96.2%、97.8%,特异性分别为56.2%、62.5%,阴性预测值分别为98.2%、99.0%,阳性预测值分别为37.8%、52.3%,正确指数分别为52.4%、60.3%;aEEG结合MRI预测神经行为学预后的敏感性(90.0%、97.0%)、特异性(89.0%、99.0%)、阴性预测值(99.2%、99.5%)、阳性预测值(80.6%、88.5%)、正确指数(79.0%、96.0%)均有提高。结论采用aEEG与MRI影像学相结合,提高了对神经发育预后的预测价值,可以为窒息早产儿脑损伤的临床随访及干预提供更好的判断依据。

Objective To study the predictive value of the amplitude-integrated electroencephalography(aEEG)within 6 hours and 3 days after birth and magnetic resonance imaging(MRI)on the adverse neurobehavioral development of asphyxiated preterm infants at the correction age of 6 months.Methods From December 2017 to June 2019,50 asphyxiated preterm infants who were delivered at the obstetrical department transferred to the division of neonatology in the Third Affiliated Hospital of Anhui Medical University were monitored by aEEG within 6 hours after birth,then once a day for at least 4 h.MRI was administered at 40 weeks of corrected age,neuromotor developmental function of the infants was assessed by the Geisel developmental diagnostic scale at 6 months of corrected age,then the infants were divided into good prognosis group and poor prognosis group according to the assessment results.SPSS 19.0 software was used for statistical analysis.The software of SPSS 19.0 was used to analyze the data.Independent sample t-test and χ^2 test were used to analyze the difference between the two groups.The relationship between aEEG grading and MRI,and their predictive value for adverse neurobehavioral development were analyzed at 6 months of corrected age.Results The degree of white matter damage(H=24.896)and intracranical hemorrhage(H=29.245)of premature infants with different aEEG clinical grades were different(both P<0.01)on MRI.The sensitivity of aEEG within 6 hours and 3 days after birth on predicting poor prognosis was 96.2% and 97.8%,the specificity was 56.2% and 62.5%,the negative predictive value was 98.2% and 99.0%,the positive predictive value was 37.8% and 52.3%,the correct index was 52.4% and 60.3%,respectively.The aEEG was combined with MRI,the sensitivity(90.0%,97.0%),specificity(89.0%,99.0%),negative predictive value(99.2%,99.5%),positive predictive value(80.6%,88.5%),and correct index(79%,96%)were all improved.Conclusion The combination of aEEG grading and MRI can improve the prognostic value on neurodevelopmental prognosis,and provide a better evaluation basis for clinical follow-up and intervention of asphyxiated premature infants with brain injury.