早产儿脑室周围白质软化的发生与预后

早产儿脑室周围白质软化(periventricular leucumalacia，PVL)会造成小儿神经系统后遗症，特别是严重的运动发育障碍，已被围生、新生儿学领域多项研究结果所证实。近年来，我国早产儿、低体重儿、多胎儿的发生率、救治成功率明显升高，然而，远期不同程度的神经发育问题也随之增加，严重影响生活质量，故不同程度的早产儿脑白质病变问题日益受到重视。     

早产儿脑室周围白质软化的研究现状

近年来，随着新生儿学的发展，尤其是新生儿重症监护病房(NICU)的建立和发展，早产儿的存活率显著提高，与之伴随的早产儿的发育障碍(如脑性瘫痪、视网膜病变、听力障碍、癫痫及精神发育迟缓等)的发病率明显增高。大量文献表明，围产期脑损伤对神经发育的影响至关重要。     

早产儿脑室周围白质软化的早期诊断

早产儿脑室周围白质软化（Periventricularleukmalailia，PVL）所致的脑性瘫痪（Cerebralpalsy，CP）有增加倾势。本文应用超声波图象诊断技术对PVL进行早期诊断，预测CP的发生，并对围生因素进行分析。一、对象：1995年11月～1997年6月在我院住院的早产）L36例进行连续超声波检查。胎龄28～32Wb9例，～34WhiZ例，～37Wkls例。出生体重一150Ogll例，～20O0gl4例，～250Og9例，＞250092例；单胎26例，双胎1O例；适于胎龄儿（AGA）23例，小于胎龄儿（SGA）13例。各种原因致低氧血症16例，颅内高压症3例，低血压2例，低PaCO21例。…     

早产儿脑室周围白质软化的多因素分析

目的　探讨早产儿脑室周围白质软化 (PVL)的高危因素。方法　对合并PVL与未合并PVL的早产儿(各 2 6例 )进行病例对照研究 ,对 18种危险因素进行Logistic回归分析。结果　胎膜早破 (PROM )、生后 4h内的pH值、动脉氧分压、生后 3d内最低二氧化碳分压、生后第 1周超声发现脑室周围强回声团 (PVE)的OR值分别为 2 383、3 2 77、3 76 9、3 96 5、1 931(P <0 0 1)。建立的早产儿PVL主效应模型为Logit(P) =β0 +0 897PROM - 1 346PaO2 - 1 2 78pH - 1 4 6 7PaCO2 +0 792PVE(χ2 =2 1 378,P =0 0 0 1)。结论　PROM、低氧血症、酸中毒、低碳酸血症、PVE为早产儿PVL的高危因素。     

早产儿脑室周围白质软化的高危因素及防治

目的 分析早产儿脑室周围白质软化(PVL)的临床资料,为早产儿PVL防治提供理论依据.方法 收集2004年1月至2008年3月我院NICU早产儿的临床资料、生后3～7 d头颅B超检查情况进行动态观察研究,对多种围生期高危因素进行Logistic回归分析.结果 835例早产儿,PVL 105例,发生率达12.6%,其中59例出现囊性变.PVL发生与下列因素有关:胎龄小、低出生体质量、窒息、肺透明膜病、呼吸暂停、呼吸衰竭、肺出血、低血糖、感染、低血压、凝血异常、低碳酸血症、胎膜早破、贫血、机械通气.结论 PVL在早产儿比较常见,其发生与多种因素密切相关,头部B超可对早产儿PVL做出早期诊断,临床上应避免或及时治疗引起PVL的因素.     

早产儿脑室周围白质软化的病因进展和临床诊断要点

早产儿的存活率和生存质量的改善是本世纪新生儿医学重点攻克的国际性目标之一。目前脑室周围白质软化(PvL)已成为早产儿脑损伤的最主要类型。在早产儿的发生率高达26％～60％。除了早期死亡外，存活患儿中，约1096可出现痉挛性运动缺陷即脑瘫，25％～50%呈现认     

早产儿脑室周围白质软化治疗进展

随着产科和新生儿重症监护技术的不断提高,早产儿存活率增加,早产儿脑损伤的发病率亦逐年增加。早产儿脑损伤包括脑室周围白质软化（PVL）、脑室内出血（IVH）、出血后脑积水等。近年来,IVH发生率呈逐渐下降趋势,因此PVL已上升为早产儿脑损伤的主要类型。正确认识及治疗早产儿PVL,对减少中枢神经系统功能障碍,降低脑瘫、认知及行为学后遗症的发生有重要意义。本文就早产儿PVL的治疗进展作一综述。[第一段]     

早期干预对脑室周围白质软化预后影响的研究

为观察早期干预对脑室周围白质软化预后的影响 ,对收住院的 6 3例早产儿进行头颅 B超监测 ,诊断 PVE或 PVL 31例 ,随机分成干预组和对照组。干预组在新生儿早期给胞二磷胆硷 1 0 0 mg/d,静点 7～ 1 0天。于修正月龄 3个月起定期门诊随诊进行运动机能训练 ,对照组常规治疗。随访至修正月龄 1 2个月以上 2 2例。结果显示 :两组轻度无统计学差异 ,而中度干预组 5例均无 CP发生 ;对照组 3例 ,其中 2例发生 CP,1例大运动发育明显延迟 ,统计学处理差异显著 (x2 :4.30 ,P<0 .0 5 ;)。本文提示 :头颅 B超可早期诊断 PVE并预测 CP发生可能性 ,早期干预对预防 CP的发生可能有一定的作用     

早产儿脑室周围白质软化的影像学研究进展

脑室周围白质软化(PVL)是早产儿脑损伤的主要形式,包括囊性和弥漫性PVL.近年来其发病率有逐渐增高趋势,已成为影响早产儿生存质量及导致小儿脑瘫的主要疾病.因早产儿PVL缺乏特异的临床表现,故其诊断必须依赖于影像学检查.B超是目前确诊PVL最常用的检测手段,但其漏诊率较高;常规磁共振成像对评价PVL的脑损伤程度及预后判定具有重要意义,但在早期,特别是对弥漫性PVL也有其局限性;而弥散加权成像作为一种新型的检测技术,弥补了B型超声及常规磁共振成像的不足,为弥漫性PVL早期诊断提供了有价值的影像学信息.     

早产儿脑室周围白质软化20例B超表现及分析

目的　分析早产儿脑室周围白质软化 (PVL)的超声表现以及预后。方法　对入住福建省妇幼保健院新生儿科所有早产儿进行常规床边头颅B超检查,对确诊为PVL的早产儿进行PVL超声图像分析并定期随访。结果　1996年底至 2004年 7月间经常规床边B超检查确诊为PVL的早产儿共 20例,其中 19例初次B超检查时间为(4 20±0 85)d,均在超声中表现为双侧脑室前角、体部或三角部外上方对称性强回声区。1例因故迟至 29日龄进行初次B超检查,显示双侧侧脑室三角部外上方已呈多发小囊腔改变。10例于 (23 6±6 1)d在原回声增强区呈现多个低回声或无回声囊腔,直径范围在 2~19 5mm,其中 2例显示囊腔分别于 41日龄和 67日龄消失。除早期死亡、自动出院及失访 12例外,余 8例患儿中,发生脑瘫 4例,疑似脑瘫 1例,其中 2例伴有智测评分低下;仅 3例 3~7个月龄随访时暂未发现异常。结论　PVL的超声表现十分典型。由于PVL患儿预后不良,对早产儿在生后早期进行常规床边头颅B超检查很有必要。     

脑白质损伤早产儿血清髓鞘碱性蛋白和S1OOB蛋白的变化及与预后的关系

目的 探讨脑白质损伤( periventricular leukomalacia,PVL)患儿血清髓鞘碱性蛋白(myelin basic protein,MBP)及S100B蛋门(S100B protein,S100B)的动态变化及其与患儿预后的关系.方法 对2007年11月至2008年7月我院住院的78例PVL早产儿(PVL组)和43例正常早产儿(正常对照组),分别在其生后第1、3、7、14天测定血清中MBP及S100B含量.30例正常早产儿及69例PVL患儿出院后每3个月随方1次,直至纠正胎龄至1岁,用Gesell发育量表测定其智力以及运动发育情况.结果 (1) PVL组患儿血清MBP于生后第1天升高[(7.61±1.78) μg/L]、第3天达峰值[( 14.53±3.12) μg/L],后随病情好转,逐渐降低;与正常对照组比较,PVL组患儿在生后第1、3、7、14天血清MBP水平均明显高于正常对照组(P＜0.05).(2) PVL组患儿血清S100B水平在生后第1、3、7天明显升高[(3.82±0.68),(4.41±0.91),(5.78±1.54) μg/L],第7天达峰值,与正常对照组比较,差异有统计学意义(P＜0.05);至生后第14天时,S100B明显降低,两组比较已无明显差异(P＞0.05).(3) PVL组患儿生后第7天血清S100B、MBP持续升高者,随访至1岁时其发育商比生后第7天血清S100B及MBP明显下降者落后;也明显落后于正常早产儿(P＜0.05).结论 PVL患儿生后血清MBP及S100B水平与病情严重程度相关.如患儿血清MBP及S100B持续升高超过7d,则发育商明显落后,预后不良.     

我国早产儿脑室周围白质软化发生率的多中心调查报告

目的：在中华医学会儿科分会新生儿学组的发起下，国内十余家大型医院于2005年1月始进行了为期近两年的《早产儿脑损伤》多中心协作研究。该文报告我国10家三级甲等医院近两年对早产儿脑室周围白质软化（PVL）发生率的调查结果。方法：2005年1月至2006年8月期间，各参加单位对所有胎龄<37周的早产儿在生后7 d内常规进行初次床边头颅B超检查，以后每隔3～7 d复查一次，直至出院。结果：10单位共出生或收住早产儿4 933例，总PVL发生率为2.3％（112/4 933），囊性PVL发生率为0.3％（16/4 933）。分别为I级PVL 85.7％（96/112），II级PVL 12.5%（14/112），III级PVL 1.8％（2/112），无IV级PVL。4家妇婴医院的早产儿PVL总发生率非常显著低于6家综合性或儿童专科医院（1.4% vs. 2.8％）（χ2＝10.284，P<0.01）。与发生囊性PVL相关的可能高危因素为阴道分娩和机械呼吸。结论：该调查数据基本可以反映我国主要大城市早产儿PVL发生率的情况。提高对PVL尤其是非囊性脑室周围白质损伤的超声识别率，是今后临床要大力加强的重点     

Amplitude-integrated electroencephalography in preterm infants with cystic periventricular leukomalacia

Aim

This study aimed to assess amplitude-integrated electroencephalography (aEEG) findings in preterm infants with cystic periventricular leukomalacia (cPVL) in the early neonatal period.

Methods

We analyzed five infants with cPVL, whose gestational age was between 27 and 30 weeks, and 15 matched control infants. Two-channel (C3-O1 and C4-O2) aEEG was obtained by digital conversion from a conventional electroencephalogram, which was recorded at days 0-5, 6-13, and 21-34 in each infant. We evaluated the averaged two-channel values of several measurements using visual and quantitative analyses.

Results

Infants with cPVL had a significant higher maximal upper-margin amplitude value, with a median of 47.5 μV (range of 42.5-60) compared with the control infants (median, 33.8; range, 23.8-50) in the second visual-analysis record. Infants with cPVL also had a significantly higher mean upper-margin amplitude value, with a median of 18.8 μV (range, 17.7-23.2) compared with the control infants (median, 16.3; range, 10.3-19.0) in the second quantitative-analysis record.

Conclusions

We demonstrated that the upper-margin amplitude of aEEG in infants with cPVL was significantly higher than that in the control infants at 6-13 days after birth.     

Altered gene expression in umbilical cord mononuclear cells in preterm infants with periventricular leukomalacia

Aim

Periventricular leukomalacia (PVL) is one of the most important causes of adverse outcome of preterm infants. We hypothesized that inflammatory or some other specific pathways will have been activated at birth in preterm infants who later develop PVL. The aim of this study is to examine the difference in mRNA expression in umbilical cord blood according to the presence or absence of PVL.

Methods

A total of 61 umbilical cord blood samples were collected from preterm infants with gestational age less than 33 weeks together with the patients' medical information during perinatal period. RNA expression patterns in the collected cord bloods were analyzed by microarray. On the basis of cranial ultrasonography and brain MRI examination, 3 infants (4.9%) were diagnosed as cystic PVL and selected as the subjects. Five patients who showed similar perinatal factors to those of infants with PVL but did not show PVL were selected as the normal control.

Results

Five of the 15 up-regulated genes are coding ribosomal proteins, and another encodes a translation elongation factor. Three of the 7 down-regulated genes encode proteins that may be related to immune response and/or inflammation.

Conclusions

Up-regulation of the ribosomal proteins may indicate an activation of lymphocytes during the fetal period.     

组织学绒毛膜羊膜炎与小于34周早产儿脑室周围白质软化的相关性分析

目的探讨组织学绒毛膜羊膜炎(histologic chorioamnionitis,HCA)与<34周早产儿脑室周围白质软化(periventricular leukomalacia,PVL)的相关性。方法选取2018年1月至12月于青岛市妇女儿童医院产科出生、孕母行胎盘病理检查并转入NICU接受治疗、胎龄<34周的早产儿作为研究对象,共计287例。根据孕母胎盘病理检查结果分为HCA阳性组(167例)和HCA阴性组(120例),比较2组患儿的PVL发生率。将研究对象中已诊断为PVL的41例早产儿,根据孕母胎盘病理检查结果及HCA分期标准,分为非HCA组、HCA早期组、HCA中晚期组3组,比较各组PVL严重程度、患儿临床资料、并发症及校正胎龄至6月龄时的随访情况。结果HCA阳性组PVL占19.16%(32/167),HCA阴性组PVL占7.50%(9/120),2组PVL发生率比较差异有统计学意义(P<0.05)。已诊断为PVL的<34周早产儿中,非HCA组21.95%(9/41),HCA早期组31.71%(13/41),HCA中晚期组46.34%(19/41),3组间PVL严重程度、1 min Apgar评分、生后24 h白细胞计数、支气管肺发育不良发生率、住院天数、抗生素应用天数、校正胎龄至6月龄时的智力发育指数(mental development index,MDI)和精神运动发育指数(psychomotor development index,PDI)比较差异均有统计学意义(P均<0.05),且HCA炎症程度与PVL严重程度呈正相关(rs=0.374,P=0.016)。结论HCA与<34周早产儿PVL的发生有相关性,随着HCA炎症程度增加,PVL的发生率、严重程度增加。母亲存在HCA的<34周早产儿随炎症严重程度进展,其生后24 h白细胞计数升高,支气管肺发育不良发生率、抗生素使用率增加,住院时间延长,校正胎龄至6月龄时MDI、PDI分数降低。     

中国人群早产儿脑室周围白质软化危险因素的meta分析

目的探讨中国人群早产儿发生脑室周围白质软化的主要危险因素,为今后防治工作提供依据。方法利用meta分析方法分析国内14篇关于早产儿脑室周围白质软化危险因素的研究文献。累计病例748例,对照3 366例。根据齐性检验结果选择计算各危险因素合并比值比(OR)及其95%可信区间(95%CI)模型。结果脑室周围白质软化发生的OR值(95%CI)分别为:产前使用激素0.46(0.34～0.61),胎膜早破3.60(1.40～9.24),胎龄5.05(2.66～9.58),低出生体质量2.78(2.30～3.35),重度窒息5.35(2.09～13.68),感染4.46(3.08～6.44),机械通气3.67(1.74～7.72),低碳酸血症4.49(2.03～9.94),脑室内出血2.00(1.15～3.45),酸中毒1.58(1.19～2.08)。结论胎膜早破、胎龄、低出生体质量、重度窒息、感染、机械通气、低碳酸血症、脑室内出血和酸中毒是中国人群早产儿脑室周围白质软化发病的主要危险因素,产前使用激素可能为脑室周围白质软化的保护因素。     

Trends in severe brain injury and neurodevelopmental outcome in premature newborn infants: the role of cystic periventricular leukomalacia

OBJECTIVES: To determine if the incidence of sonographically detected cystic periventricular leukomalacia (PVL) and periventricular hemorrhagic infarction (PVHI) have changed over the past decade and to determine if a decline in cystic PVL was associated with a change in neurodevelopmental outcome. STUDY DESIGN: Premature newborn infants admitted to our intensive care nursery from 1992 to 2002 were identified in a comprehensive nursery database. Premature newborn infants had routine neurosonography by means of a standardized protocol. Infants weighing < or =1500 g at birth surviving to nursery discharge were enrolled in a nursery follow-up clinic. RESULTS: Adjusting for gestational age, there was a significant decrease in cystic PVL from 1992 to 2002 (P=.003) without a concurrent decrease in PVHI (P=0.5). Cystic PVL and PVHI accounted for only 9 of the 28 cases of cerebral palsy and 12 of 90 cases of abnormal Developmental Scores in infants weighing <1500 g at birth. The decline in cystic PVL was not associated with improved developmental outcome from 1992 to 2002. CONCLUSIONS: The incidence of cystic PVL declined significantly from 1992 to 2002 at our center. Cystic PVL was detected by ultrasound in a minority of infants with abnormal neurodevelopmental outcome, indicating that other forms of cerebral injury account for the majority of abnormal neurodevelopmental outcomes in premature newborn infants.     

Late-onset circulatory dysfunction of premature infants and late-onset periventricular leukomalacia

Background: The sudden appearance of hypotension and oliguria without obvious cause following stable circulation and respiration in preterm infants is frequent in Japan. Such episodes are referred to as late‐onset circulatory dysfunction of premature infants (LCD). Volume expanders and inotropic agents are often ineffective against this condition, whereas i.v. steroids are significantly effective. A major problem is that cystic periventricular leukomalacia (PVL) often develops a few weeks after an episode. The aim of the present study was to clarify the risk factors, including LCD, related to cystic PVL. Methods: A case–control study was performed for preterm infants who were delivered at <33 weeks of gestation and admitted to seven neonatal intensive care units in Japan. Cystic PVL infants were stratified into early‐onset PVL diagnosed within 28 days of age and late‐onset PVL diagnosed after more than 28 days of age. The reported and new risk factors for PVL, for each group of PVL infants, and for all PVL infants, were compared with controls. Results: Thirty‐two infants were diagnosed with cystic PVL (17 early‐onset and 15 late‐onset). All PVL infants significantly differed from controls on Apgar score, number of abortions and pregnancies, intraventricular hemorrhage, and LCD. LCD was diagnosed in 28.1% of both PVL groups compared with 6.3% of controls (P = 0.02). Multivariate analysis demonstrated significant association between late‐onset PVL and LCD. Conclusion: LCD was significantly associated with cystic PVL, especially late‐onset PVL. Elucidating the cause of LCD might reduce the incidence of PVL and improve the neurological prognosis of preterm infants.