侧脑室周围白质软化症脑瘫儿童的临床特征

Clinical Features of Cerebral Palsy Children with Periventricular Leukomalacia in MRI

目的:探讨侧脑室周围白质软化症(periventricular leukomalacia,PVL)脑瘫患儿的临床及MRI特点。方法:从我院电子病历信息系统中回顾性提取自2011年1月1日至2021年12月31日在郑州大学第三附属医院儿童康复科住院康复的18岁以下脑瘫儿童信息,比较和分析头颅MRI表现为PVL脑瘫患儿的孕周、出生体重、分型、粗大运动功能分级(gross motor function classification system,GMFCS)、共患病等方面的不同。结果:共纳入2012例脑瘫患儿,进行头颅MRI检查并有结果记录者共1419例,PVL共645例(45.45%),早产417例(64.65%),低出生体重患儿375例(58.14%);在有PVL分级结果的321例患儿中,PVL分级为Ⅱ级者在孕周<32周脑瘫患儿中占比最高,为72.53%(8/77),孕周与PVL分级有统计学差异(P<0.01);在出生体重方面,PVL分级为Ⅱ级者在出生体重1500~2500 g及<1500 g脑瘫患儿中占比分别为71.21%(94/132)和62.5%(25/40),不同出生体重儿的PVL分级分布差异均有统计学意义(P<0.05)。在型别方面,痉挛型双瘫占比57.36%(370/645),痉挛型四肢瘫占比17.36%(112/645);在GMFCS分级方面,具有独走能力者占比65.89%(425/645)。在有PVL分级结果的321例患儿中,PVL为Ⅲ级者痉挛型偏瘫占比最高,为53.49%(46/86),在GMFCS分级方面,PVL分级为Ⅱ级者GMFCS为Ⅰ、Ⅱ级者占比最低,为48.84%(105/215),型别、GMFCS分级与PVL分级之间差异均有统计学意义(P<0.01);在共患病方面,最后一次随访年龄>4岁的有505例,其中共患智力障碍181例(35.84%),共患癫痫78例(12.09%),共患视力障碍71例(11.01%)。在有PVL分级结果的321例患儿中,PVL分级为Ⅱ级者共患癫痫及智力障碍率均最高,分别为17.03%(31/182)和40.16%(49/122),PVL分级与是否共患癫痫及智力障碍均存在统计学差异(均P<0.05),PVL分级与是否共患听力障碍、视力障碍均无统计学意义(P>0.05)。结论:头颅MRI为PVL的脑瘫患儿的孕周、临床表现、合并症呈现一定的特点,头颅MRI可以为围产期预防、临床早期诊断、早期干预及减少后遗症提供重要依据。

Objective:To investigate the clinical and MRI characteristics of cerebral palsy children with periventricular leukomalacia(PVL).Methods:We retrospectively extracted information from the electronic medical record system of the Third Affiliated Hospital of Zhengzhou University on cerebral palsy children under 18 years old who were hospitalized for rehabilitation from January 1,2011,to December 31,2021.We compared and analyzed different aspects such as gestational weeks,birth weight,classification,Gross Motor Function Classification System(GMFCS),and comorbidities in children with cerebral palsy whose cranial MRI showed PVL.Results:A total of 2012 children with cerebral palsy were included,and among them,1419 underwent cranial MRI with recorded results.PVL was found in 645 cases(45.45%),including 417 preterm infants(64.65%)and 375 low birth weight infants(58.14%).Among the 321 cases with PVL grading results,grade II PVL accounted for the highest proportion in children with gestational age<32 weeks at 72.53%(8/77),and there was a statistical difference in gestational weeks and PVL grades(P<0.01).Regarding birth weight,grade II PVL accounted for 71.21%(94/132)in children with birth weights between 1500-2500 g and 62.5%(25/40)in those<1500 g,with statistical differences in the distribution of PVL grades across different birth weights(P<0.05).In terms of classification,spastic diplegia accounted for 57.36%(370/645)and spastic tetraplegia for 17.36%(112/645).Regarding GMFCS levels,65.89%(425/645)had the ability to walk independently.In the 321 cases with PVL grading results,grade III PVL had the highest proportion of spastic hemiplegia at 53.49%(46/86).In terms of GMFCS levels,grade II PVL had the lowest proportion of levels I and II at 48.84%(105/215),and there were statistical differences between types,GMFCS levels,and PVL grades(P<0.01).Regarding comorbidities,among the 505 cases whose last follow-up age was>4 years,there were 181 with intellectual disabilities(35.84%),78 with epilepsy(12.09%),and 71 with visual impairments(11.01%).In the 321 cases with PVL grading results,those with grade II PVL had the highest rates of comorbid epilepsy and intellectual disabilities,at 17.03%(31/182)and 40.16%(49/122),respectively,with statistical differences between PVL grades and whether there was comorbid epilepsy or intellectual disability(both P<0.05),but no statistical significance between PVL grades and whether there was comorbid hearing or visual impairment(P>0.05).Conclusion:Children with cerebral palsy and PVL detected by cranial MRI present certain characteristics in terms of gestational age,clinical manifestations,and comorbidities.Cranial MRI can provide important evidence for perinatal prevention,early clinical diagnosis,early intervention,and the reduction of sequelae.