系统评价早产对儿童智力发育的影响及早期干预作用

目的：评价早产对儿童智力发育的影响及早期干预的作用。方法：检索Cochrane图书馆、PubMed、EMBASE、万方数据库、中国期刊全文数据库和中国维普数据库，检索起止时间均为1980年1月至2011年11月。由2名系统评价员进行资料提取和质量评价，数据分析采用RevMan 5.0.13软件，检验异质性，并根据异质性结果选择相应的效应模型。结果:共纳入18项研究评价早产对儿童智力发育的影响，15项研究（16篇文献）评价早期干预对早产儿智力心理发育的作用。9篇文献提及随机分配方法，9篇文献提及分配方案隐藏，9篇文献提及对研究对象、治疗方案实施者、研究结果测量者采用盲法，12篇文献提及结果数据的完整性，10篇文献提及选择性报告研究结果，没有文献提及其他偏倚来源。早产儿智商（IQ）明显低于足月儿（SMD=-11.62，95％CI: -13.21~-10.03），差异有统计学意义（Z=14.37，P<0.001）。对胎龄与IQ的关系进行分层分析，发现胎龄越低，IQ越低，儿童期随访，IQ从胎龄34~36周的112.7逐渐降至胎龄25周的82.1。对早期干预的作用进行了评价，各组婴儿（早产儿纠正年龄）于生后6、12、18、24、36个月采用贝利婴儿发育量表（BSID）测定智力发育指数（MDI）和运动发育指数（PDI），结果表明早期干预组MDI与PDI均较对照组显著提高，P均<0.01。早期干预可显著降低早产儿智力异常的发生率（OR= 0.25，95％CI: 0.15~0.41）。结论:本Meta分析表明早产儿IQ明显低于足月儿，并随着胎龄的降低而逐渐减低，对早产儿早期干预可明显改善早产儿智力水平，降低智力异常的发生率。但早产儿干预仍缺少长期的随访研究，需要进一步的评价。

Systematic review of influence of preterm birth on the intellectual development and the effect of early intervention

Objectives：To assess preterm birth on the intellectual development and the effect of early intervention. Methods：The Cochrane library,PubMed,EMBASE,Wanfang,CNKI and VIP were searched from January 1980 to November 2011. Two reviewers assessed the quality of included studies and extracted data. All included studies were graded on sequence generation,allocation concealment,blinding,incomplete outcome data,selective outcome reporting, and other sources of bias.Statistical analysis was performed employing RevMan 5.0.13 software. Heterogeneity of the included articles was tested to select proper effect model. Results：Eighteen studies were included to assess influence of preterm birth on intellectual development, fifteen studies were included to analyze the effect of early intervention to preterm infants. Sequence generation, allocation concealment, blinding, the integrity of outcome data, and selective outcome reporting were mentioned by 9, 9, 9, 12 and 10 studies respectively. None of studies mentioned other sources of bias. The intelligence quotient (IQ) of preterm infants was significantly lower than term infants, SMD=-11.62 (95％CI: -13.21 to -10.03). The stratified analysis on the relationship between IQ and gestational age (GA) showed that IQ was lower in lower GA. IQ reduced from 112.7 for infants with GA of 34-36 weeks to 82.1 for those with GA of 25 weeks. The effect of early intervention on preterm infants was evaluated based on MDI and PDI by using the Bayley Scales of Infant Development (BSID) at 6, 12, 18, 24, and 36 months at corrected GA. The results showed that MDI and PDI were increased obviously in the intervention group. Five studies reported that early intervention reduced the incidence of mental abnormalities in preterm infants (OR= 0.25，95％CI: 0.15 to 0.41). Conclusions：The results showed IQ of preterm infants was significantly lower than the term infants. Lower IQ was seen in infants with lower GA. Early intervention could significantly improve the IQ of preterm infants and reduce the incidence of mental abnormalities. Long term effect of early intervention on IQ needs long-term follow-up studies and evaluation.