磁共振量化评分在脑白质损伤早产儿脑成熟度评估中的应用

Application of magnetic resonance quantitative score on the assessment of brain maturity in preterm infants with white matter injury

目的探讨校正胎龄足月时早产儿脑白质损伤(white matter injury,WMI)与脑成熟度的关系。方法选择2017年1月至2018年8月西安交通大学第一附属医院、2017年1~6月西北妇女儿童医院新生儿科收治且在校正胎龄37~42周完成常规头颅磁共振成像(magnetic resonance imaging,MRI)检查的早产儿(胎龄≤32周或出生体重≤1500 g)进行回顾性分析,根据WMI评分系统将早产儿分为WMI组和对照组,比较两组脑成熟度总评分(total maturation score,TMS)及4个亚项评分。结果共纳入早产儿118例,WMI组17例,对照组101例,胎龄(30.3±1.7)周,出生体重(1356±268)g。WMI组TMS落后比例高于对照组[58.8%(10/17)比31.7%(32/101)],TMS低于对照组[(10.7±1.8)分比(11.8±1.5)分],差异均有统计学意义(P<0.05)。TMS亚项评分中,WMI组髓鞘化评分[(2.8±0.6)分比(3.1±0.4)分]和胶质细胞移行带评分[(1.6±0.4)分比(2.1±0.6)分]均低于对照组,差异有统计学意义(P<0.05);两组皮层折叠和生发基质评分差异无统计学意义(P>0.05)。结论WMI早产儿较无WMI早产儿脑成熟度明显落后,主要体现在髓鞘化成熟落后及胶质细胞移行带消失延迟。

Objective To study the relationship between white matter injury(WMI)and brain maturity in preterm infants at full-term corrected gestational age(cGA).Methods A retrospective study was performed in preterm infants[GA≤32 weeks or birth weight(BW)≤1500 g]admitted to the neonatal intensive care unit of the First Affiliated Hospital of Xi'an Jiaotong University from January 2017 to August 2018 and the Northwest Women and Children's Hospital from January 2017 to June 2017.The infants received conventional magnetic resonance imaging(MRI)at cGA 37~42 weeks.The infants were assigned into the WMI group and the control group according to the WMI scoring system,including the total maturation scores(TMS)and four sub-item scores.Results A total of 118 premature infants were enrolled in this study(17 cases in the WMI group and 101 cases in the control group).The GA was(30.3±1.7)weeks,and BW was(1356±268)g.The proportion of delayed TMS in the WMI group was significantly higher than the control group[58.8%(10/17)vs.31.7%(32/101),P<0.05].The TMS of the WMI group were significantly lower than the control group[(10.7±1.8)vs.(11.8±1.5),P<0.05].The sub-item scores of TMS showed that the myelination[(2.8±0.6)vs.(3.1±0.4),P<0.05]and glial cell migration bands of the WMI group[(1.6±0.4)vs.(2.1±0.6),P=0.004]were significantly lower than the control group and no significant differences existed in cortical folding and involution of germinal matrix tissue scores between the two groups.Conclusions The brain maturity of preterm infants with WMI is substantially delayed than those without WMI,including delayed myelination and delayed disappearance of glial cell migration bands.