早期头颅超声检查对早产儿颅内病变及运动和智力发育迟缓的诊断价值

Value of early cranial ultrasonography in diagnosing intracranial lesions, motor and mental retardation in preterm infants

目的 探讨在早产儿和超早产儿脑室周围-脑室内出血(PIVH)、新生儿局灶性脑白质损伤(PWML)以及运动和智力发育迟缓的诊断中实施颅脑超声检查的临床价值。方法 选取2020年3月至2021年3月登封市人民医院收治的早产儿和超早产儿75例,于出生后3 d内进行颅脑超声检查,所有患儿均进行常规扫查及大脑中动脉阻力指数(MCA-RI)测量,对检查结果为PIVH、PWML的患儿依据分类标准进行分级,同时应用灰度值测量脑白质异常区域。对胎龄纠正后予以1年出院随访观察,并应用运动发育指数(PDI)、智力发育指数(MDI)对患儿进行评估。结果 PIVH为Ⅳ级的患儿有1例,出现运动和智力发育迟缓,此例同时合并MCA-RI增高;PWML为Ⅳ级的患儿有2例,均出现运动和智力发育迟缓,2例均合并MCA-RI增高;分类为Ⅲ级的PIVH患儿有4例,其中3例患儿运动发育迟缓,2例智力发育迟缓,4例中3例合并MCA-RI增高,1例合并MCA-RI降低;分类为Ⅲ级的PWML患儿有4例,其中2例患儿运动发育迟缓,3例智力发育迟缓,4例中3例合并MCA-RI增高,1例MCA-RI正常范围;分类为Ⅱ级的PIVH患儿有5例,其中1例运动发育迟缓,1例智力发育迟缓,5例中3例合并MCA-RI增高,2例MCA-RI正常范围;分类为Ⅱ级的PWML患儿有6例,其中1例患儿运动发育迟缓,2例智力发育迟缓,6例中3例合并MCA-RI增高,2例合并MCA-RI降低,1例MCA-RI正常范围;不同程度的PIVH和PWML,运动及智力发育迟缓预后差异有统计学意义(P<0.05),同时颅脑超声多参数表明,MCA-RI具有较高的敏感度和特异度,灰度值与PDI及MDI关系均呈负相关(P<0.05)。结论 在PIVH、PWML以及运动和智力发育迟缓的评估中进行颅脑超声多参数检查意义显著,通过对PIVH、PWML进行分级、MCA-RI及灰度值判定,可以为临床及早采取针对性治疗提供有力依据。

Objective To investigate the clinical value of cranial ultrasonography in diagnosing periventricular-intraventricular hemorrhage(PIVH)preterm and very preterm infants,as well as punctate white matter lesions(PWML),and motor and mental retardation in preterm infants. Methods Seventy-five preterm and very premature infants admitted to our hospital between March 2020 and March 2021 were recruited and underwent cranial ultrasonography within 3 days of birth,which included routine ultrasound scanning and measurement of the middle cerebral artery resistance index(MCA-RI). The infants found to have PIVH or PWML were graded according to relevant classification criteria,and further measure for grey-scale value of the abnormal brain white matter areas. Adjusted for gestational age,the infants were followed up for one year after discharged home on evaluation for the motor development index(PDI) and mental development index(MDI).Results Grade Ⅳ PIVH was identified in only one infant who also had motor and mental retardation and elevated MCA-RI. Grade Ⅳ PWML was identified in 2 infants, all of whom had motor and mental retardation and elevated MCA-RI. Grade Ⅲ PIVH was identified in 4 infants,accompanied by motor retardation in 3 and mental retardation in 1 infant;among these 4 infants with grade Ⅲ PIVH,MCA-RI was elevated in 3 and decreased in 1. There were 4 infants with grade Ⅲ PWML, of whom, 2 had with motor retardation and 3 had mental retardation;among these 4 infants with grade Ⅲ PWML,MCA-RI was elevated in 3 and within normal range in 1. Grade Ⅱ PIVH was identified in 5 infants with motor retardation in 1 and mental retardation in another;among these 5 infants with grade Ⅱ PIVH,MCA-RI was elevated in 3 and within normal range in 2. Grade ⅡPWML was identified in 6 infants with motor retardation in 1 and mental retardation in 2;among these 6 infants with Grade Ⅱ PWML,MCA-RI was elevated in 3,decreased in 2,and within normal range in 1. The prognosis of motor and mental retardation varied significantly across severities of PIVH and PWML(P<0.05). As shown by multiple parameters of the cranial ultrasonography, MCA-RI offered high diagnostic sensitivity and specificity,and the grey-scale values of white matter were negatively correlated with either PDI or MDI(P <0.05).Conclusion Cranial ultrasonography with multiple parameters is of paramount importance in evaluating PIVH,PWML,and motor and mental retardation in preterm and very preterm infants and,by classification of PIVH and PWML as well as measurement of grey-scale value of white matter,offers strong evidence for early implementation of specific treatment in clinical settings.