aEEG联合GMs量表对早产脑损伤高危儿神经发育结局的预测研究

Predictive study of aEEG combined with GMS on neurodevelopmental outcomes of high risk infants with brain injury

目的探讨振幅整合脑电图(amplitude-integrated electroencephalography,aEEG)联合全身运动(general movements,GMs)对早产脑损伤高危儿神经发育结局的预测效能。方法回顾性分析出生胎龄分别为28~31周(196例)、32~33周(205例)、34~36周(209例)的早产脑损伤高危儿的资料,分别记为A组、B组、C组。3组均采用aEEG检查和GMs评估,且均随访至12月龄明确神经发育结局。对比各组、A+B+C组神经发育异常和正常者aEEG异常率、GMs异常率;绘制受试者操作特征曲线(receiver operator characteristic curve,ROC曲线)评价aEEG联合GMs对各组、A+B+C组神经发育异常的预测价值。结果 A组发育迟缓、脑瘫、神经发育异常率均高于B组、C组,B组发育迟缓、脑瘫、神经发育异常率均高于C组,差异均有统计学意义(P<0.01);A+B+C组发育迟缓、脑瘫、神经发育异常率分别为13.44%、3.93%、19.02%;A组、B组、C组及A+B+C组中神经发育异常者aEEG异常率、GMs异常率均高于神经发育正常者,差异均有统计学意义(P<0.05);aEEG联合GMs预测A组、B组、C组、A+B+C组神经发育异常的灵敏度均与aEEG、GMs单独预测相近,而特异度、准确度、AUC均高于单独预测,AUC与单独预测对比差异均有统计学意义(P<0.05)。结论早产脑损伤高危儿神经发育异常率高,且与出生胎龄有关,aEEG联合GMs对早产脑损伤高危儿神经发育异常的预测效能高。

Objective To investigate the predictive effect of amplitude-integrated electroencephalogram(aEEG)combined with general movements(GMs) on neurodevelopmental outcomes in high-risk infants with premature brain injury.Methods The data of high-risk premature infants with gestational age of 28-31 weeks(196 cases), 32-33 weeks(205 cases)and 34-36 weeks(209 cases) were retrospectively analyzed, which were recorded as A group, B group and C group respectively. The three groups were evaluated by aEEG and GMs, and were followed up to 12 months to determine the neurodevelopmental outcomes. The abnormal rates of aEEG and GMs were compared among groups, A+B+C group. Receiver operating characteristic curve(ROC curve) was drawn to evaluate the predictive value of aEEG combined with GMs for neurodevelopmental abnormalities in every group and A+B+C group. Results The rates of developmental retardation, cerebral palsy and neurodevelopmental abnormalities in group A were higher than those in group B and group C. The rates of developmental retardation, cerebral palsy and neurodevelopmental abnormalities in group B were higher than those in group C(P<0.01),which were 13.44%, 3.93% and 19.02% respectively in group A+B+C. In group A, group B, group C and group A+B+C, the abnormal rates of AEEG and GMs in group A, group B, group C and group A+B+C were higher than those with normal neurodevelopment(P<0.05). The sensitivities of aEEG combined with GMs in predicting neurodevelopmental abnormalities in groups A, B, C and A+B+C were similar to those of aEEG and GMs alone, and the specificity, accuracy and AUC values were higher than those of single prediction, and the differences in AUC between the combine and single prediction were statistically significant(P<0.05). Conclusion The rate of neurodevelopmental abnormalities in high-risk infants with premature brain injury is high, and it is related to the gestational age. aEEG combined with GMs has a high predictive effect on neurodevelopmental abnormalities in high-risk infants with premature brain injury.