振幅整合脑电图联合头颅磁共振预测早产儿矫正12月龄时神经发育的价值

Predictive value of aEEG combined with cranial MRI on neurodevelopment for preterm infants at corrected age of 12 months

目的探讨振幅整合脑电图(aEEG)联合头颅磁共振成像(cMRI)对早产儿矫正12月龄时神经发育的预测价值。方法选取110例早产儿为研究对象,并在矫正12月龄时采用Gesell发育量表评估发育商(DQ),依据DQ分为Gesell正常组(DQ≥85,n=83)、Gesell异常组(DQ<85,n=27)。采集早产儿及母亲临床资料,对比两组出生后72 h内aEEG、矫正胎龄37周时cMRI检查指标差异。结果两组早产儿及母亲基线资料比较差异无统计学意义(P>0.05)。相较于Gesell正常组,Gesell异常组双顶径(BPW)降低[(70.68±5.32)mm vs(66.54±3.69)mm],睡眠-觉醒周期(SWC)不成熟率(20.48%vs 85.19%)、aEEG异常率(30.12%vs 70.37%)、两半球间距(IHD)增高[(2.95±0.83)mm vs(3.56±0.72)mm](P<0.05)。Pearson相关分析结果显示,DQ值与IHD呈负相关,DQ值与BPW呈正相关(r=-0.361、0.598,P<0.05)。二元Logistic回归分析结果显示,BPW增高是Gesell异常的独立保护因素(P<0.05),IHD增高、SWC不成熟及aEEG异常是Gesell异常的独立危险因素(P<0.05)。结论早产儿出生后72 h内aEEG异常、矫正胎龄37周时cMRI异常可能提示矫正12月龄时不良神经发育结局。

Objective To evaluate the predictive value of amplitude-integrated electroencephalogram combined with cranial magnetic resonance on neurodevelopment for preterm infants at corrected age of 12 months.Methods A total of 110 preterm infants were selected as study subjects,and Gesell developmental scale was used to evaluate developmental quotient(DQ)at corrected age of 12 months.According to DQ,they were divided into normal Gesell group(DQ≥85,n=83)and abnormal Gesell group(DQ<85,n=27).Clinical data of preterm infants and their mothers were collected,and the differences of amplitudeintegrated electroencephalogram and cranial MRI(cMRI)were compared between two groups.Results There was no significant difference in baseline data between two groups(P>0.05).Compared with the normal Gesell group,the biparirtal width(BPW)in the abnormal Gesell group was decreased(70.68±5.32mm vs 66.54±3.69mm),the immaturity rate of sleep-wake cycle(SWC)20.48%vs 85.19%,the abnormal rate of aEEG(30.12%vs 70.37%),and(IHD)(2.95±0.83mm vs 3.56±0.72mm)were increased(P<0.05).The results of Pearson correlation analysis showed that DQ was negatively correlated with IHD,and DQ was positively correlated with BPW(r=-0.361、0.598,P<0.05).Binary Logistic regression analysis showed that increased BPW was an independent protective factor for abnormal Gesell(P<0.05),and increased IHD,immature SWC and abnormal aEEG were independent risk factors for abnormal Gesell(P<0.05).Conclusions Abnormal aEEG within 72h after birth and abnormal cMRI at corrected age of 37 weeks may lead to adverse neurodevelopmental outcomes at corrected age of 12 months.