早产儿局灶性脑白质损伤的多因素分析
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摘要
目的探讨早产儿局灶性脑白质损伤(puncate white matter damage,PWMD)的影响因素,并着重分析不同胎龄和出生体重与早产儿PWMD类型的关系。方法选取2013年9月至2017年7月在本院新生儿科病房住院的132例PWMD的早产儿及109例MRI表现正常的早产儿作为研究对象,用卡方检验分析早产儿PWMD的各影响因素,用Logistic回归具体探讨早产儿PWMD的危险因素及保护性因素,并分别用卡方检验和秩和检验对其中的胎龄和体重着重分析,进一步了解不同类型的PWMD早产儿的胎龄及出生体重的分布情况。结果 PWMD的影响因素有早期早产儿、低出生体重儿、患儿呼吸系统感染、呼吸窘迫、母亲孕期感染、剖宫产、脐绕颈、胎膜早破;其中呼吸系统感染(OR=7. 679,P=0. 000)、呼吸窘迫(OR=6. 330,P=0. 000)及胎膜早破(OR=2. 455,P=0. 013)是危险性因素;剖宫产(OR=0. 406,P=0. 012)、晚期早产儿(OR=0. 162,P=0. 000)及正常出生体重儿(OR=0. 489,P=0. 035)是保护性因素。晚期早产儿比早期早产儿点状、簇状损伤的发生率高;早期早产儿比晚期早产儿线状损伤的发生率高。低出生体重儿,线状损伤的发生率高;正常出生体重儿,点及簇状损伤的发生率高。结论呼吸系统感染、早产儿呼吸窘迫及胎膜早破的早产儿出现PWMD的机率更大;早期早产儿及低出生体重早产儿线状损伤的发生率高,预后相对较差。
Objective To investigate the influencing factors of puncate white matter damage in premature infants,and analyze the relationship between different gestational ages and birth weights and the types of PWMD in premature infants.Methods A total of 132 premature infants with PWMD and 109 preterm infants with normal MRI were enrolled in the neonatal ward from September 2013 to July 2017. The chi-square test was used to analyze the influencing factors of PWMD in premature infants. Logistic regression was used to investigate the risk factors and protective factors of premature infants with PWMD. The chi-square test and rank-sum test were used to analyze the gestational age and body weight,and to understand the gestational age and birth of different types of PWMD preterm infants and the distribution of weight. Results The factors affecting PWMD were early premature infants,low birth weight infants,respiratory infections in children,respiratory distress,maternal infection during pregnancy,cesarean section,umbilical cord around neck,premature rupture of membranes; respiratory infection( OR = 7. 679,P = 0. 000),respiratory distress( OR = 6. 330,P = 0. 000) and premature rupture of membranes( OR = 2. 455,P = 0. 013) were risk factors; cesarean section( OR = 0. 406,P = 0. 012),advanced preterm birth Children( OR = 0. 162,P = 0. 000) and normal birth weight infants( OR = 0. 489,P = 0. 035) were protective factors. Late preterm infants have a higher incidence of punctate and cluster-like lesions than early preterm infants;early preterm infants have a higher incidence of linear lesions than late preterm infants. In low birth weight infants,the incidence of linear injury is high; in normal birth weight infants,the incidence of punctate and cluster injury is high. Conclusion Preterm infants with respiratory infection,premature infants with respiratory distress and premature rupture of membranes have a greater chance of developing PWMD. Early preterm infants and low birth weight preterm infants have a higher incidence of linear injury and a poorer prognosis.
Objective To investigate the influencing factors of puncate white matter damage in premature infants,and analyze the relationship between different gestational ages and birth weights and the types of PWMD in premature infants.Methods A total of 132 premature infants with PWMD and 109 preterm infants with normal MRI were enrolled in the neonatal ward from September 2013 to July 2017. The chi-square test was used to analyze the influencing factors of PWMD in premature infants. Logistic regression was used to investigate the risk factors and protective factors of premature infants with PWMD. The chi-square test and rank-sum test were used to analyze the gestational age and body weight,and to understand the gestational age and birth of different types of PWMD preterm infants and the distribution of weight. Results The factors affecting PWMD were early premature infants,low birth weight infants,respiratory infections in children,respiratory distress,maternal infection during pregnancy,cesarean section,umbilical cord around neck,premature rupture of membranes; respiratory infection( OR = 7. 679,P = 0. 000),respiratory distress( OR = 6. 330,P = 0. 000) and premature rupture of membranes( OR = 2. 455,P = 0. 013) were risk factors; cesarean section( OR = 0. 406,P = 0. 012),advanced preterm birth Children( OR = 0. 162,P = 0. 000) and normal birth weight infants( OR = 0. 489,P = 0. 035) were protective factors. Late preterm infants have a higher incidence of punctate and cluster-like lesions than early preterm infants;early preterm infants have a higher incidence of linear lesions than late preterm infants. In low birth weight infants,the incidence of linear injury is high; in normal birth weight infants,the incidence of punctate and cluster injury is high. Conclusion Preterm infants with respiratory infection,premature infants with respiratory distress and premature rupture of membranes have a greater chance of developing PWMD. Early preterm infants and low birth weight preterm infants have a higher incidence of linear injury and a poorer prognosis.
引文
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2彭小明,高喜容,孙正香,等.早产儿重度脑室周围-脑室内出血临床高危因素分析[J].中国新生儿科杂志,2011,26:386-388.
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5王钰,尹晓娟,李丽华,等.窒息新生儿并发脑损伤相关因素分析[J].中国儿童保健杂志,2013,21:746-749.
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9李艳,杜奕,陈志强,等.弥散加权成像早期诊断早产儿脑白质损伤及预后评估[J].中国医学影像技术,2014,30:1-5.
10潘广赉,杨明,莫坤梅,等.宫内感染与早产儿脑损伤的关系[J].中华实用儿科临床杂志,2011,26:363-364.
11感染与早产儿脑白质损伤[J].中国小儿急救医学,2004,11:216-217.
12 Berger I,Peleg O,Ofek-Shlomai N.Inflammation and early brain injury in term and preterm infants[J].Israel Medical Association Journal Imaj,2012,14:318-323.
13杨印祥,索磊,杜庆安,等.缺氧时间对脑白质损伤程度影响的实验研究[J].临床儿科杂志,2015,33:883-886.
14 Kersbergen KJ,Benders MJNL,Groenendaal F,et al.Different Patterns of Punctate White Matter Lesions in Serially Scanned Preterm Infants[J].PLo SONE,2014,9:e108904.
2彭小明,高喜容,孙正香,等.早产儿重度脑室周围-脑室内出血临床高危因素分析[J].中国新生儿科杂志,2011,26:386-388.
3 Cornette LG,Tanner SF,Ramenghi LA,et al.Magnetic resonance imaging of the infant brain:anatomical characteristics and clinical significance of punctate lesions[J].Arch Dis Child Fetal Neonatal Ed,2002,86:171-177.
4邹林霞,蒙丹华,陈维华,等.新生儿脑损伤相关因素分析[J].中国妇幼保健,2016,31:3763-3765.
5王钰,尹晓娟,李丽华,等.窒息新生儿并发脑损伤相关因素分析[J].中国儿童保健杂志,2013,21:746-749.
6 Liu Q,Wang YQ,Zhang YF,et al.Diagnostic value and influencing factors for amplitude-integrated EEG in brain injury in preterm infants[J].Chinese Journal of Contemporary Pediatrics,2015,17:435-439.
7马力,温晓红,杨海波,等.影响早产儿脑损伤的相关因素分析[J].中国当代儿科杂志,2016,18:471-475.
8 Perez-Roche T,Altemir I,Giménez G,et al.Effect of prematurity and low birth weight in visual abilities and school performance[J].Research in Developmental Disabilities,2016,59:451-457.
9李艳,杜奕,陈志强,等.弥散加权成像早期诊断早产儿脑白质损伤及预后评估[J].中国医学影像技术,2014,30:1-5.
10潘广赉,杨明,莫坤梅,等.宫内感染与早产儿脑损伤的关系[J].中华实用儿科临床杂志,2011,26:363-364.
11感染与早产儿脑白质损伤[J].中国小儿急救医学,2004,11:216-217.
12 Berger I,Peleg O,Ofek-Shlomai N.Inflammation and early brain injury in term and preterm infants[J].Israel Medical Association Journal Imaj,2012,14:318-323.
13杨印祥,索磊,杜庆安,等.缺氧时间对脑白质损伤程度影响的实验研究[J].临床儿科杂志,2015,33:883-886.
14 Kersbergen KJ,Benders MJNL,Groenendaal F,et al.Different Patterns of Punctate White Matter Lesions in Serially Scanned Preterm Infants[J].PLo SONE,2014,9:e108904.