基于动脉自旋标记成像技术探讨支气管肺发育不良对早产儿脑血流量影响的前瞻性研究

Influence of bronchopulmonary dysplasia on cerebral blood flow in preterm infants:a prospective study based on arterial spin labeling

目的应用动脉自旋标记(arterial spin labeling,ASL)成像技术测量的脑血流值(cerebral blood flow,CBF)评价支气管肺发育不良(bronchopulmonary dysplasia,BPD)早产儿局部大脑皮质血流灌注量。方法采用前瞻性研究方法,选择2021年8月—2022年6月在郑州大学第三附属医院产科出生并转入新生儿科的胎龄<32周、出生体重<1500 g,于纠正胎龄35~40周完成头颅磁共振成像及ASL检查的90例早产儿为研究对象,根据是否诊断为BPD分为BPD组(n=45)和非BPD组(n=45),比较两组早产儿ASL相同感兴趣区(额叶、颞叶、顶叶、枕叶、丘脑和基底神经节)CBF值的差异。结果与非BPD组早产儿相比,BPD组早产儿1 min Apgar评分更低,辅助通气时间更长,胎儿窘迫发生率更高,差异均有统计学意义(P<0.05)。应用多元线性回归分析控制头颅磁共振成像检查时纠正胎龄、日龄等混杂因素后,与非BPD组相比,BPD组左右两侧额叶、颞叶、顶叶、枕叶、基底神经节、丘脑的CBF值仍较高(P<0.05)。结论BPD可使早产儿大脑皮质血流灌注量增高,可能与前期缺氧、较长时间辅助通气有关。

Objective To investigate local cerebral blood perfusion in preterm infants with bronchopulmonary dysplasia(BPD)based on cerebral blood flow(CBF)values of arterial spin labeling(ASL).Methods A prospective study was conducted on 90 preterm infants with a gestational age of<32 weeks and a birth weight of<1500 g who were born in the Department of Obstetrics and admitted to the Department of Neonatology in the Third Affiliated Hospital of Zhengzhou University from August 2021 to June 2022.All of the infants underwent cranial MRI and ASL at the corrected gestational age of 35-40 weeks.According to the presence or absence of BPD,they were divided into a BPD group with 45 infants and a non-BPD group with 45 infants.The two groups were compared in terms of the CBF values of the same regions of interest(frontal lobe,temporal lobe,parietal lobe,occipital lobe,thalamus,and basal ganglia)on ASL image.Results Compared with the non-BPD group,the BPD group had a significantly lower 1-minute Apgar score,a significantly longer duration of assisted ventilation,and a significantly higher incidence rate of fetal distress(P<0.05).After control for the confounding factors such as corrected age and age at the time of cranial MRI by multiple linear regression analysis,compared with the non-BPD group,the BPD group still had higher CBF values of the frontal lobe,temporal lobe,parietal lobe,occipital lobe,basal ganglia,and thalamus at both sides(P<0.05).Conclusions BPD can increase cerebral blood perfusion in preterm infants,which might be associated with hypoxia and a long duration of assisted ventilation in the early stage.