早产儿脑白质损伤核磁共振成像定量评估与血细胞参数和围产期因素的相关性分析

Correlation Analysis of MRI Quantitative Assessment of White Matter Damage with Blood Cell Parameters and Perinatal Factors in Premature Infants

【目的】探讨早产儿脑白质损伤(WMD)的围产期高危因素及血细胞参数的相关性,为早期发现并规避早产儿WMD的发生提供科学依据。【方法】采用回顾性病例对照研究设计,收集南方医科大学附属深圳市妇幼保健院新生儿科2018年1月1日至2020年12月31日经核磁共振检查诊断为WMD的早产儿85例为病例组,并以胎龄为匹配条件选取同期115例经核磁共振检查未诊断WMD患者作为对照组。采用SPSS22.0统计学软件进行围产期相关因素的单因素分析、血细胞参数单因素分析、构建多因素Logistic回归模型分析WMD的相关因素,并对其中有意义的连续性变量进行接受者操作特性曲线分析,以获得WMD危险因素截断值,最后进行有序Logistic回归分析WMD严重程度的影响因素。【结果】①围产期相关因素单因素分析显示,两组在孕期贫血率、产前足疗程激素使用率、早发败血症发生率、机械通气(≥7 d)比例、低血压发生率、早产儿脑室周围-脑室内出血(PIVH)Ⅲ-Ⅳ级及有血流动力学意义的动脉导管未闭(hsPDA)发生率之间的差异均有统计学意义(均P<0.05)。②生后第1周的两组血细胞参数单因素分析显示,两组在生后第1周的白细胞(WBC)、中性粒细胞(NEUT)、单核细胞(MONO)、平均红细胞体积(MCV)、平均血红蛋白量(MCH)、血小板(PLT)、血小板压积(PCT)、平均血小板体积(MPV)、血小板分布宽度(PDW)之间的差异均有统计学意义(均P<0.05)。③Logistic回归模型显示,机械通气(≥7 d)是WMD发生的独立危险因素,而生后1周内较高的MCH和PLT以及产前足疗程激素治疗是WMD发生的保护因素。④MCH诊断WMD的AUC为0.708,95%CI为(0.595,0.820),截断值为37.10 pg。PLT诊断WMD的AUC为0.669,95%CI为(0.551,0.787),截断值为227.50×10^(9)/L。⑤有序Logistic回归分析,结果显示:早发型败血症是WMD严重程度的危险因素,而胎龄和血小板分布宽度则是其保护因素及血细胞学指标。【结论】早产儿机械通气(≥7 d)、生后1周血细胞MCH和PLT减低可能是预测早产儿WMD发生的独立危险因素及相关血细胞学指标,而产前应用足疗程的糖皮质激素则是其保护因素;早发型败血症及越小的胎龄及PDW可能是WMD严重程度的危险因素。

【Objective】To explore the correlation between perinatal risk factors and blood cell parameters of white matter damage(WMD)in premature infants and to provide scientific basis for early detection and avoidance of WMD in premature infants.【Methods】This is a retrospective study performed at the Neonatal Department,Affiliated Shenzhen Maternity&Child Healthcare Hospital,from January 1st 2018 to December 31st 2020.The case group included 85 premature infants diagnosed as WMD by MRI,and 115 premature infants without WMD matched by gestational age and admission date constituted the control group.SPSS 22.0 statistical software was used to conduct univariate analysis of perinatal related factors and blood cell parameters,and to construct a multivariate Logistic regression model to analyze WMD related factors.Meaningful continuous variables were analyzed by the receiver operating characteristic curve to obtain the cut-off value of WMD risk factors.Then ordinal Logistic regression was used to analyze the influencing factors of WMD severity.【Results】①There were no significant differences in sex ratio,twins rate,gestational age,birth weight,cesarean section rate,assisted reproductive technology pregnancy rate,Apgar score at 1 and 5 minutes after birth,and age at diagnosis between the two groups(P>0.05).②Univariate analysis of perinatal factors showed that there were significant differences between the two groups in the rate of anemia during pregnancy,antenatal glucocorticoid treatment,the incidence of earlyonset sepsis,neonatal hypotension,PIVH(grade Ⅲ-Ⅳ)and hsPDA,the proportion of mechanical ventilation(≥7 d)(P<0.05).③Univariate analysis of blood cell parameters in the first week after birth showed that there were significant differences in WBC,Neut,Mono,MCV,MCH,PLT,PCT,MPV and PDW between the two groups(P<0.05).④Logistic regression model showed that mechanical ventilation(≥7 d)was an independent risk factor for WMD,while higher MCH and PLT within one week after birth and antenatal glucocorticoid treatment were protective factors for WMD.⑤The AUC of MCH in the diagnosis of WMD was 0.708,95%CI was(0.595-0.820),and the cut-off value was 37.10 pg.The AUC of WMD diagnosed by PLT was 0.669,95%CI was(0.551-0.787)and the cut-off value was 227.50×10^(9)/L.⑥Ordered Logistic regression showed that early-onset sepsis was a risk factor for the severity of WMD,while gestational age and platelet distribution width were its protective factors and hematology indicators【.Conclusions】Mechanical ventilation(≥7 d)decreased MCH and PLT counts may be independent risk factors for WMD in preterm infants,and antenatal glucocorticoids treatment is a protective factor.Early-onset sepsis,smaller gestational age and PDW may be risk factors for the severity of WMD.