脑瘫儿童高危因素及其与粗大运动功能的关联分析

Association analysis between high risk factors and gross motor function in children with cerebral palsy

目的了解脑性瘫痪(脑瘫)儿童发生的高危因素,以及与脑瘫患儿粗大运动功能分级(grossmotorfunctionclassification system,GMFCS)间的相关性,为防治脑瘫及预测脑瘫患儿粗大运动功能分级程度,从而降低脑瘫及运动功能损伤的发生率提供参考依据。方法选择2020年6月至2021年6月在郑州大学第三附属医院儿童康复科诊治的338名脑瘫儿童作为病例组,同期来我院儿童保健科进行正常体检的845例健康儿童作为对照组。采用Logistic回归分析确认最终的危险因素,并进一步分析高危因素与GMFCS分级的相关性。结果多因素回归分析显示11种危险因素是脑瘫发生的独立高危因素,产前因素如宫内窘迫(OR=6.992,95%CI:1.607~30.412),产时因素如早产(OR=7.111,95%CI:2.532~19.970)、低出生体重(OR=8.665,95%CI:3.176~23.644),产后因素如重度黄疸(OR=11.900,95%CI:5.123~27.645)、新生儿颅内出血(OR=6.727,95%CI:2.422~18.685)等,差异有统计学意义(P<0.05);早产(OR=2.357,95%CI:1.107~5.021)与脑瘫患儿GMFCS分级密切相关(P<0.05),可用于预测脑瘫患儿的运动功能损伤程度。结论脑瘫发生的高危因素复杂多样,有宫内窘迫、早产、低出生体重、重度黄疸等。高危因素中早产可用于预测脑瘫患儿运动功能损害程度。针对高危因素提早预防,可减低脑瘫及其运动功能损伤的发生率。

Objective To analyze the risk factors of cerebral palsy,and the association of gross motor function classification system(GMFCS)with cerebral palsy,and provide theoretical evidence for preventing the incidence of cerebral palsy and predicting the gross motion function in patients with cerebral palsy and reducing the incidence of cerebral palsy and motor function damage.Methods A total of 338 children with cerebral palsy hospitalized in Rehabilitation Center,The Third Affiliated Hospital of Zhengzhou University from June 2020 to June 2021 were selected as case group,and 845 healthy children who underwent normal physical examination in the Department of Children’s Health of the hospital during the same period were selected as control group.All data were analyzed with univariate analysis and multivariate Logistic regression to confirm the final risk factors.Results Multivariate regression analysis showed that prenatal factors such as fetal distress(OR=6.992,95%CI:1.607-30.412),production factors such as premature birth(OR=7.111,95%CI:2.532-19.970),low birth weight(OR=8.665,95%CI:3.176~23.644),postpartum factors such as severe jaundice(OR=11.900,95%CI:5.123-27.645),neonatal intracranial hemorrhage(OR=6.727,95%CI:2.422-18.685)and so on were independently associated with cerebral palsy in children(P<0.05).Moreover,premature delivery(OR=2.357,95%CI:1.107-5.021)was significantly associated with GMFCS in children of cerebral palsy(P<0.05).Thus,these risk factors could be used to predict the level of damage in motion function of children with cerebral palsy.Conclusion There are various risk factors of cerebral palsy,such as fetal distress,preterm delivery,low birth weight,severe jaundice,and so on.Of the risk factors,premature delivery can be used to predict the damage level of gross motor function in children with cerebral palsy.Measures targeting at the high-risk factors should be taken to reduce the incidence of gross motor function damage.