应用弥散张量成像评价支气管肺发育不良早产儿脑白质发育的研究

目的 应用磁共振弥散张量成像（DTI）的各项异性分数（FA）和表观弥散系数（ADC）评价支气管肺发育不良（BPD）早产儿的脑白质发育。方法 以2016年8月至2019年4月生后24 h内收住NICU的出生胎龄≤32周、出生体重<1 500 g,且出院前完成头颅MRI及DTI检查的96例早产儿为研究对象。根据出院诊断分为BPD组（n=48）和非BPD组（n=48）,比较两组DTI相同感兴趣区的FA值和ADC值。结果 两组早产儿脑室周围-脑室内出血、脑室周围白质软化、局灶性脑白质损伤等发生率差异无统计学意义（P > 0.05）。BPD组早产儿内囊后肢、胼胝体压部、枕叶白质、小脑、大脑脚的FA值低于非BPD组（P < 0.05）,各ADC值高于非BPD组（P < 0.05）。与非BPD组相比,BPD组早产儿呼吸暂停次数更多、肺炎发生率和机械通气比例更高、辅助通气时间更长（P < 0.05）。结论 BPD对早产儿脑白质发育具有潜在影响,可导致脑白质发育延迟,因此,需关注该类患儿的神经功能。     

弥散张量成像在早产儿脑白质损伤神经发育评价中的应用

脑白质损伤是早产儿最常见的脑损伤形式,是造成神经和智力损伤以及后期脑性瘫痪的主要原因.影像学检查在脑白质损伤的早期诊断及后期随访中发挥着重要的作用.其中核磁共振因为其安全准确的特点已成为目前应用最普遍的影像学检查.有别于传统的核磁共振技术,弥散张量成像可以在活体内观察和定量分析脑白质纤维束,现已成为评价脑白质损伤的有力工具.该文对弥散张量成像在早产儿脑白质损伤神经发育评价中的应用进行综述.     

磁共振弥散张量成像在早产儿脑白质发育及脑损伤中的应用

脑白质损伤及发育异常是导致早产儿在儿童期及青春期出现神经发育障碍的主要原因.弥散张量成像利用水分子弥散技术,可以研究早产儿脑白质成熟发育的特征,并进一步揭示早产儿脑损伤的类型及发病机制.     

NBNA评分联合磁共振弥散张量成像在早产儿脑白质发育评价中的作用及相关性分析

目的 探讨早产儿磁共振弥散张量成像中的各向异性分数(fractional anisotropy,FA)与新生儿行为神经测定(Neonatal Behavioral Neurological Assessment,NBNA)评分的相关性,从影像学角度评价FA在早产儿脑白质发育中的诊断价值.方法 前瞻性选择2016年10月...     

早产儿微小型脑白质损伤的MRI-DTI评价

目的 应用磁共振弥散张量成像(DTI)对不同程度的微小型脑白质损伤(CWMD)进行评价, 探讨DTI 在早产儿CWMD 中的应用价值。方法 选取2011 年11 月至2012 年4 月住院治疗的31 例早产儿, 分为局灶性CWMD 组11 例, 广泛性CWMD 组10 例, 同时正常对照组10 例, 比较三组患儿侧脑室旁的表观弥散系数(ADC)值及各向异性(FA)值, 应用Pearson 系数检验ADC 值及FA 值变化的相关性, 同时观察三组患儿的彩色FA 图。结果 局灶性CWMD 组及广泛性CWMD 组的ADC 值均高于正常组, 差异有统计学意义。局灶性CWMD 组及广泛性CWMD 组FA 值均低于正常组, 广泛性CWMD 组FA 值低于局灶性CWMD 组, 差异均有统计学意义。经过后处理的FA 彩图提示侧脑室周围白质区域的FA 值按正常组、局灶CWMD 组及广泛CWMD 组顺序依次减低。结论 弥散张量成像技术可定量评估微小型CWMD 程度。在CWMD 评价方面, FA 值比ADC 值可能更加准确。     

早期应用重组人促红细胞生成素对早产儿脑白质发育的影响

目的 应用磁共振弥散张量成像（DTI）的部分各项异性参数（FA）评价早期应用重组人促红细胞生成素（rhEPO）对早产儿脑白质发育的影响。方法 以81例胎龄≤ 32周、出生体重 < 1 500 g、生后24 h内住院的早产儿为研究对象,随机分为两组：rhEPO组（42例）使用rhEPO治疗,对照组（39例）使用等体积的生理盐水注射。2组均于纠正胎龄35~37周行头部MRI、DWI、DTI检查,并测定相同感兴趣区的部分各项异性参数（FA）。结果 两组早产儿颅内出血、脑室周围白质软化、局灶性脑白质损伤、广泛性脑白质损伤等发生率的差异无统计学意义（P > 0.05）。rhEPO组早产儿内囊后肢、胼胝体压部、额叶白质、枕叶白质FA值高于对照组（P < 0.05）,2组早产儿顶叶白质、丘脑、豆状核、尾状核FA值的差异无统计学意义（P > 0.05）。结论 早期应用重组人红细胞生成素对早产儿脑白质发育有神经保护作用。     

磁共振弥散张量成像定量评价生长受限胎儿脑白质发育的研究

目的探讨胎儿生长受限(FGR)是否对胎儿脑白质发育造成不良影响。方法选择28例足月小于胎龄儿(SGA)为研究对象,15例足月适于胎龄儿(AGA)为对照组,均行头颅磁共振及磁共振弥散张量成像(DTI),将颅脑白质分为122个脑区,比较两组不同脑区各向异性分数(FA)、平均弥散系数(MD)、平行弥散系数(λ_//)及垂直弥散系数(λ_⊥)的差异。结果 SGA儿16个脑区的FA值低于对照组(P0.01);7个脑区的MD值高于对照组(P0.05);8个脑区的λ_//值高于对照组(P0.05);16个脑区的λ_⊥值高于对照组(P0.05)。结论宫内生长受限可导致脑白质纤维束成熟度及完整性异常。     

早产儿支气管肺发育不良的防治

随着围生医学的发展,早产儿存活率上升,支气管肺发育不良(bronchopulmonary dysplasia,BPD)发病率也逐年增高.BPD是一种由多因素引发的慢性肺疾病,其病因及发病机制复杂,早期病死率高,晚期伴有呼吸系统,甚至神经系统的不良结局,严重影响早产儿存活率及生活质量.该文就BPD的防治进展作一综述.     

磁共振弥散张量成像评价新生儿脑损伤

磁共振弥散张量成像技术（diffusion tensor imaging,DTI）是一种无创性的磁共振成像方法,通过计算表观弥散系数、各向异性系数、相对各向异性系数、纵向弥散系数等参数能够定量评价脑组织正常结构、脑发育状况与脑损害,是目前唯一可在活体上观察脑白质纤维走行及微结构变化的成像技术.本文对其在评价新生儿脑损伤与脑发育中的应用进展予以介绍.     

肺发育和肺损伤-新型支气管肺发育不良

近年基于接受机械通气治疗早产儿的病理表现、支气管肺发育不良 (ＢＰＤ)流行病变化特点、及实验模型研究的最新结果 ,提出“新ＢＰＤ”的概念。以前认为ＢＰＤ的病理生理特征是 :严重的气道上皮发育不良及损伤、气道平滑肌增生、肺实质纤维化及局限性肺气肿。这些损害是由于机     

Diffusion tensor imaging in preterm infants with punctate white matter lesions

Our aim was to compare white matter (WM) microstructure in preterm infants with and without punctate WM lesions on MRI using tract-based spatial statistics (TBSS) and probabilistic tractography. We studied 23 preterm infants with punctate lesions, median GA at birth 30 (25-35) wk, and 23 GA- and sex-matched preterm controls. TBSS and tractography were performed to assess differences in fractional anisotropy (FA) between the two groups at term equivalent age. The impact of lesion load was assessed by performing linear regression analysis of the number of lesions on term MRI versus FA in the corticospinal tracts in the punctate lesions group. FA values were significantly lower in the posterior limb of the internal capsule, cerebral peduncles, decussation of the superior cerebellar peduncles, superior cerebellar peduncles, and pontine crossing tract in the punctate lesions group. There was a significant negative correlation between lesion load at term and FA in the corticospinal tracts (p = 0.03, adjusted r2 = 0.467). In conclusion, punctate lesions are associated with altered microstructure in the WM fibers of the corticospinal tract at term equivalent age.     

Conductive hearing loss in preterm infants with bronchopulmonary dysplasia

OBJECTIVE: To determine the risk of conductive hearing loss in preterm infants with bronchopulmonary dysplasia (BPD) and preterm controls. METHODOLOGY: The study population consisted of 78 infants with BPD of 26-33 weeks gestation and 78 controls of similar gestational age matched for broad-based birthweight categories. An auditory brainstem response (ABR) audiology was performed shortly before hospital discharge. Visual reinforcement orientation audiometry (VROA) and impedance audiometry were performed at 8-12 months corrected for prematurity. Infants with persistent audiological abnormalities were referred for evaluation to paediatric ENT surgeons. RESULTS: Infants with BPD had a significantly higher rate of ABR abnormalities (BPD: 22%, controls: 9%; P = 0.028). On VROA and impedance audiometry, the infants with BPD also had a higher rate of persistent abnormalities. Following ENT assessment, 22.1% of infants with BPD and 7.7% of controls had persistent conductive dysfunction requiring myringotomy and grommet tube insertion (P = 0.03). Most of these infants had normal ABR audiometry at hospital discharge. CONCLUSIONS: Preterm infants with BPD are at high risk of persistent conductive hearing loss late in the first year of life compared to controls. An ABR audiology conducted at the time of hospital discharge does not predict accurately later conductive hearing problems. Infants with BPD should have routine audiological evaluation toward the end of the first year of life.     

Neurodevelopmental outcome of preterm infants with bronchopulmonary dysplasia.

The neurodevelopmental outcome of 78 infants with bronchopulmonary dysplasia (BPD) was compared with that of 78 control infants matched for birthweight. To determine the effect of the severity of BPD, 62 infants requiring oxygen at 36 weeks'' postmenstrual age (sBPD) were compared with their matched controls. Infants were followed up to 2 years of age, corrected for prematurity, and were classified for neurological impairment, developmental delay, and neurodevelopmental disability. Seventy six (98%) BPD infants and 71 (91%) controls had follow up data available to two years. Neurological impairment, developmental delay, and neurodevelopmental disability occurred more frequently in infants with BPD than in controls but this was not significant. For infants with sBPD, the increased incidence of neurological impairment and definite developmental delay was not significant when compared with the controls, though neurodevelopmental disability occurred more frequently (odds ratio (OR) 3.6: 95% confidence intervals (CI) 1.1-11.8). Predictors of disability in infants with sBPD included periventricular haemorrhage (OR 19.4: 95% CI 4.3-86.6), ventricular dilatation (OR 12.8: 95% CI 2.9-57.3), and sepsis (OR 5.0: 95% CI 1.3-19.4). Adjusting for the presence of these factors, the association between BPD and disability was no longer apparent (OR 0.9: 95% CI 0.2-3.6). The findings suggest that BPD is not independently associated with adverse neurodevelopmental outcome.     

Growth and development of preterm infants with respiratory distress syndrome and bronchopulmonary dysplasia

This study examines the growth and development of 37 preterm infants, 20 with respiratory distress syndrome and 17 with bronchopulmonary dysplasia. The groups were balanced by sex, parity, family configuration, and socioeconomic status and were studied at either 12 or 18 months after hospital discharge. Findings indicate that infants with bronchopulmonary dysplasia are at greater risk for growth retardation in their second year than infants with respiratory distress syndrome. Furthermore, results from cognitive, sensorimotor, and language measures (the Bayley, Uzgiris-Hunt, and Receptive-Expressive Emergent Language scales) demonstrate that infants with bronchopulmonary dysplasia perform significantly less well than infants with respiratory distress syndrome. The group performance of the infants with respiratory distress syndrome suggests that their developmental scores are comparable to those of average, healthy full-term infants of the same age. In contrast, the group of infants with bronchopulmonary dysplasia performed in the low-average to delayed range. Moreover, regression analyses show that type of respiratory illness explains more of the variance in cognitive outcomes than such neonatal factors as birth weight or gestational age. Thus, this study demonstrates that infants with bronchopulmonary dysplasia are at high risk for developmental problems in their second year, and that the contribution of bronchopulmonary dysplasia to explanations of differential cognitive outcomes cannot be reduced to between-group differences in perinatal status.     

早产儿支气管肺发育不良预测标志物的研究进展

支气管肺发育不良( bronchopulmonary dysplasia,BPD)是早产儿最常见的严重呼吸系统疾病,严重影响早产儿的生存质量,至今还没有预防和治疗BPD的有效方法。由于BPD的发病机制是多因素的,涉及多种不同的信号分子途径,因此测定体液中的相应标志物有可能早期预测新生儿BPD的发生。