早產兒腦白質損傷影像學特征與神經發育的關系

張洪濤

[摘要] 目的 觀察早產兒腦白質損傷（WMD）的影像學特征，探討其與神經發育的關系。 方法 選取2014年8月～2016年8月秦皇島市婦幼保健院收治的62例早產兒WMD患兒作為觀察組，根據損傷類型分為局灶性WMD組（點簇狀病灶組、線狀病灶組）和彌漫性WMD組，另選取30名健康早產兒及30名健康足月新生兒分別作為對照組和足月組。分析早產兒WMD的影像學表現與神經發育的關系。 結果 62例WMD患兒中局灶性WMD 48例（點簇狀病灶36例、線狀病灶12例），彌漫性WMD 14例；出生30 d后，33例患兒病灶消失，21例病灶面積減小，8例出現白質軟化（PVL）。觀察組患兒矯正胎齡40周時的新生兒行為神經評分（NBNA）及出生后3個月的運動發育指數（PDI）和（MDI）評分均顯著高于對照組和足月組（P < 0.05）；點簇狀病灶組患兒的NBNA、PDI和MDI評分均顯著高于線狀病灶組和彌漫性WMD組（P < 0.05）；復查時病灶消失組患兒的PDI和MDI評分顯著高于病灶面積減少組和PVL組（P < 0.05）。 結論 新生兒WMD患兒的MRI特征與近期神經發育存在一定相關性，在患兒神經發育預后狀況評估中具有重要價值。

[關鍵詞] 早產兒；腦白質損傷；磁共振成像；彌漫加權成像；神經發育

[中圖分類號] R72 [文獻標識碼] A [文章編號] 1673-7210（2017）05（a）-0113-04

Relationship between imaging features and neurodevelopment in premature infants with white matter injury

ZHANG Hongtao

Department of Radiology， Maternal & Child Health Care Hospital of Qinhuangdao， Hebei Province， Qinhuangdao 066000， China

[Abstract] Objective To observe the imaging features of white matter injury （WMD） in premature infants， in order to explore its relationship with neurodevelopment. Methods From August 2014 to August 2016， 62 cases of preterm infants with WMD admitted in Maternal & Child Health Care Hospital of Qinhuangdao were selected as the observation group， and the infants were divided into focal WMD group （cluster lesion group， linear lesion group） and diffuse WMD group， according to the type of injury. Then 30 cases of healthy preterm infants and full-term newborns were selected as control group and full-term group respectively. The relationship between WMD imaging and neurodevelopment was analyzed. Results There were 48 cases of focal WMD， in which 36 cases were cluster lesions and 12 cases were linear lesions， and 14 cases of diffuse WMD among 62 cases of WMD infants. 30 days after the birth， lesions of 33 cases was disappeared， lesions of 21 cases was decreased and lesions of 8 cases was developed into PVL. The scores of NBNA， PDI and MDI of the observation group were significantly higher than those of the control group and full-term group at 40th week of gestational age or 3 months after the birth （P < 0.05）. The NBNA， PDI and MDI scores of infants in cluster lesion grop were significantly higher than those in linear lesion group and diffuse WMD group （P < 0.05）. The PDI score and MDI score of the infants in lesion disappeared group were significantly higher than those in the lesion reduction group and PVL group （P < 0.05）. Conclusion The MRI features of neonates with WMD have a certain correlation with the recent neurodevelopment， which is of great value in the assessment of neurodevelopmental prognosis.

[Key words] Premature infants； White matter damage； Magnetic resonance imaging； Diffusion-weighted imaging； Neurodevelopment

腦白質損傷（WMD）是早產兒常見的腦損傷形式，近年來隨著極低體重早產兒成活率的提高，WMD患兒的發生率亦隨之升高，同時臨床研究顯示早產兒尤其是極低體重兒中約有10%會出現腦癱，其中約50%存在不同程度的WMD，因此對早產兒WMD的及早診治具有重要臨床意義[1-2]。但早產兒WMD在早期缺乏特異的臨床表現或神經系統異常癥狀，臨床診斷主要依據影像學特征，目前WMD的影像學檢查多停留于特征診斷而有關其與神經發育之間相關性的探究尚處于探索階段[3-4]。因此，本研究對秦皇島市婦幼保健院（以下簡稱“我院”）確診為早產兒WMD患兒的常規磁共振（MRI）及彌散加權成像（DWI）圖像特征進行分析，并探討其與患兒神經發育相關量化評分的關系，具體結果如下。……