早产儿脑白质损伤后期脑体积变化与临床关系的研究

目的 探讨早产儿脑白质损伤后期脑体积变化与损伤程度及预后的关系. 方法 选取不同程度白质损伤的早产儿34例为研究对象,25例无白质损伤早产儿为对照,利用三维超声对侧脑室三角区及其周围脑实质进行体积测量,计算脑实质比值.随访中分别在纠正年龄至40周、1月、3月、6月及以后的时间进行全面的神经系统及体格发育检查,6月内进行体积跟踪测定. 结果 纠正年龄40周、1月、3月、6月时,脑实质比值在对照组早产儿分别为0.923±0.021,0.919±0.022,0.915±0.036,0.916±0.009,在轻度脑室旁白质损伤早产儿分别为0.931±0.016,0.908±0.026,0.922±0.013,0.912±0.029,在重度脑室旁白质损伤早产儿分别为0.880±0.028,0.886±0.061,0.868±0.042,0.861±0.044,落后于轻度损伤及对照组,组间差异有统计学意义(P＜0.05).脑实质比值重度异常者临床上会出现神经系统发育的异常,其重度神经系统异常的发生率(50%)远远高于脑实质比值正常和轻度异常者(5%,22%),P=0.0168. 结论 早产儿脑室周围白质损伤导致脑室周嗣的脑实质体积减少,脑室增大,脑实质比值减小.早期脑室周围白质损伤越重,体积减少越明显,脑实质比值减小越明显.脑实质比值的异常程度与神经发育异常有关.

Relationship between the later changes of brain volume and the clinical manifestation after the preterm white matter damage

Objective To explore the association of the later changes of brain volume,the degrees of early white matter injury and the prognosis after the preterm white matter damage in the preterm infants.Methods Thirty-four cases of preterm infants with varying degrees of brain white matter injury were recruited for study.Twenty-five cases of normal preterm infants were selected as the normal control group.The three-dimensional(3D)ultrasound was used to measure the volumes of lateral ventricles triangle and para-ventricular brain matter,and figure out the brain matter ratio.During the follow-up period,these cases were receiveel the systemic nervous system examination and medical examination as well as the volume tracked measurement at the corrected gestational age of 40 weeks,1 months,3 months,6 months and the latertimes.Results At the corrected gestational age of 40 weeks,1 months,3 months and 6 months,the brain matter ratios of normal control group were 0.923±0.021,0.919±0.022,0.915±0.036,0.916±0.009,respectively.In the mild white matter injury infants,the brain matter ratios were 0.931±0.016.0.908±0.026,0.922±0.013,0.912±0.029.In the early severe paraventricular white matter injury preterm infants,the brain matter ratios were 0.880±0.028,0.886±0.061,0.868±0.042,0.861±0.044,lagging behind those in the mild injury and non-injury groups.Significant difference was found in three groups(P＜0.05).In the severe abnormalities of brain matter ratios cases,50%would exhibit severe abnormalities of nervous system,markedly higher than those in the other two groups(22%and 5%)(P=0.0168).Concluesions Preterm brain paraventricular matter injury incressed the brain ventricular volume and decressed the volume of brain paraventrieular matter,the brain matter ratio decreased at the same time.The more severe the brain paraventricular matter damage.the more markedly the volumes and the matter ratios decreased.The degree of the abnormal brain matter ratio was related with the neurological developmental abnormalities in preterm infants.