小于32周极低出生体重儿足月时脑内代谢物水平预测神经系统发育的临床研究

发布时间：2018-05-07 14:41

本文选题：小于32周极低出生体重儿 + 磁共振波谱　；参考：《广州医科大学》2017年硕士论文

【摘要】：目的:通过磁共振波谱成像技术检测早产儿足月时的脑内代谢物水平,探讨:(1)脑内代谢物能否预测神经系统发育状况;(2)有多少种脑内代谢物能够预测神经系统发育状况;(3)哪一种脑内代谢物预测神经系统发育状况的能力最好;(4)哪一区域的脑内代谢物预测神经系统发育状况的能力最好;(5)能够预测的最佳时间点。方法:1.对入组的早产儿在纠正足月时行MRI平扫和MRS扫描。2.对入组的早产儿在纠正6月和纠正1岁时行AIMS评估和GESELL评估。结果:1.一般资料中的分类变量(性别、胎数、未足月胎膜早破、出生前激素使用、迟发败血症、脑室内出血、脑室周围白质软化、母亲职业情况、母亲教育情况、动脉导管未闭、产后类固醇使用、脑干诱发电位、试管婴儿、窒息程度、新生儿缺氧缺血性脑病、高胆红素血症、宫内感染、妊高症、难产、先兆流产)分别与结局变量(纠正6月AIMS得分、发育商;纠正1岁AIMS得分、发育商)进行pearson相关分析发现,脑室周围白质软化与纠正6月AIMS得分呈负相关(P0.05),即脑室周围白质软化程度越高,纠正6月AIMS得分越低;脑室周围白质软化与纠正1岁发育商呈负相关(P0.05),即脑室周围白质软化程度越高,纠正1岁发育商越低;窒息程度与纠正1岁AIMS得分、纠正1岁发育商呈负相关(P0.05),即窒息程度越严重,纠正1岁AIMS得分、纠正1岁发育商越低;窒息程度与纠正6月社交行为呈负相关(P0.05),即窒息程度越严重,纠正6月社交行为得分越低。窒息程度与纠正1岁大动作、纠正1岁社交行为呈负相关(P0.05),即窒息程度越严重,纠正1岁大动作、纠正1岁社交行为得分越低。2.一般资料中的连续变量(孕周、出生体重、1分钟Apgar评分、5分钟Apgar评分、辅助通气天数、需要氧疗天数、住院天数、出生头围、出生身长)分别与结局变量(纠正6月AIMS得分、发育商;纠正1岁AIMS得分、发育商)进行pearson相关分析发现,辅助通气天数与纠正1岁AIMS得分呈负相关(P0.05),即辅助通气天数越多,纠正1岁AIMS得分越低;孕周与纠正6月大动作呈正相关(P0.05),即孕周越大,纠正6月大动作得分越高;孕周与纠正1岁适应性呈正相关(P0.05),即孕周越大,纠正1岁适应性得分越高。3.一般资料中的分类变量(出生体重、窒息程度、新生儿缺氧缺血性脑病、高胆红素血症、颅内出血、宫内感染、妊高症、难产、先兆流产)与结局变量(脑瘫)进行单因素卡方分析发现,差异无统计学意义,P0.05。4.额叶代谢物(NAA、Cho、Cr、MI、Lac、NAA/Cr、Cho/Cr、MI/Cr、Lac/Cr)分别与结局变量(纠正6月AIMS得分、发育商;纠正1岁AIMS得分、发育商)进行pearson相关分析发现,差异均无统计学意义,P0.05。5.基底节代谢物(NAA、Cho、Cr、MI、Lac、NAA/Cr、Cho/Cr、MI/Cr、Lac/Cr)分别与结局变量(纠正6月AIMS得分、发育商;纠正1岁AIMS得分、发育商)进行pearson相关分析发现,基底节MI浓度与纠正1岁发育商呈负相关(P0.05),即基底节MI浓度越高,纠正1岁发育商越低;基底节MI浓度与纠正1岁大动作、精细动作、适应性、社交行为呈负相关(P0.05),即基底节MI浓度越高,纠正1岁大动作、精细动作、适应性、社交行为得分越低;基底节Cho/Cr比值与纠正1岁精细动作呈负相关(P0.05),即基底节Cho/Cr比值越大,纠正1岁精细动作得分越低;基底节MI/Cr比值与纠正1岁大动作、精细动作、适应性、语言、社交行为呈负相关(P0.05),即基底节MI/Cr比值越大,纠正1岁大动作、精细动作、适应性、语言、社交行为得分越低。6.海马区代谢物(NAA、Cho、Cr、MI、Lac、NAA/Cr、Cho/Cr、MI/Cr、Lac/Cr)分别与结局变量(纠正6月AIMS得分、发育商;纠正1岁AIMS得分、发育商)进行pearson相关分析发现,海马区Lac/Cr比值与纠正6月发育商呈负相关(P0.05),即海马区Lac/Cr比值越高,纠正6月发育商越低;海马区NAA/Cr比值与纠正6月大动作呈正相关(P0.05),即海马区NAA/Cr比值越高,纠正6月大动作得分越高;海马区MI浓度与纠正1岁适应性呈负相关(P0.05),即海马区MI浓度越高,纠正1岁适应性得分越低。7.脑室周围代谢物(NAA、Cho、Cr、MI、Lac、NAA/Cr、Cho/Cr、MI/Cr、Lac/Cr)分别与结局变量(纠正6月AIMS得分、发育商;纠正1岁AIMS得分、发育商)进行pearson相关分析发现,脑室周围Lac浓度与纠正1岁发育商呈负相关(P0.05),即脑室周围Lac浓度越高,纠正1岁发育商越低;脑室周围Lac/Cr比值与纠正1岁AIMS得分、纠正1岁发育商呈负相关(P0.05),即脑室周围Lac/Cr比值越高,纠正1岁AIMS得分、纠正1岁发育商越低;脑室周围Lac浓度与纠正1岁大动作、精细动作呈负相关(P0.05),即脑室周围Lac浓度越高,纠正1岁大动作、精细动作得分越低;脑室周围MI/Cr比值与纠正1岁大动作呈负相关(P0.05),即脑室周围MI/Cr比值越大,纠正1岁大动作得分越低;脑室周围Lac/Cr比值与纠正1岁大动作、精细动作呈负相关(P0.05),即脑室周围Lac/Cr比值越大,纠正1岁大动作、精细动作得分越低。8.小脑代谢物(NAA、Cho、Cr、MI、Lac、NAA/Cr、Cho/Cr、MI/Cr、Lac/Cr)分别与结局变量(纠正6月AIMS得分、发育商;纠正1岁AIMS得分、发育商)进行pearson相关分析发现,小脑Lac浓度与纠正1岁发育商呈负相关(P0.05),即小脑Lac浓度越高,纠正1岁发育商越低;小脑Lac/Cr比值与纠正1岁发育商呈负相关(P0.05),即小脑Lac/Cr比值越高,纠正1岁发育商越低;小脑Lac/Cr比值与纠正1岁大动作呈负相关(P0.05),即小脑Lac/Cr比值越高,纠正1岁大动作得分越低。9.多因素线性回归分析:单因素(一般资料、各感兴趣区脑内代谢物)与结局变量(纠正6月AIMS得分、发育商;纠正1岁AIMS得分、发育商)进行pearson相关分析后,将分析有统计学意义的变量作为自变量,结局变量(纠正6月AIMS得分、发育商;纠正1岁AIMS得分、发育商)作为因变量进行多因素线性回归分析发现:早产儿纠正6月发育商、精细动作的影响因素是海马区Lac/Cr比值;早产儿纠正1岁AIMS得分的影响因素是窒息程度和辅助通气天数;早产儿纠正1岁发育商的影响因素是基底节MI/Cr比值、脑室周围Lac浓度、脑室周围白质软化、小脑Lac/cr比值;早产儿纠正1岁大动作、精细动作、适应性、语言、社交行为的影响因素分别是基底节MI浓度、基底节MI/Cr比值、基底节MI/Cr比值、基底节MI/Cr比值、基底节MI/Cr比值。结论:1.早产儿足月时脑内代谢物水平有助于预测神经系统发育状况。2.脑内代谢物MI浓度、Lac浓度、NAA/Cr比值、Cho/Cr比值、MI/Cr比值、Lac/Cr比值有助于预测神经系统发育状况。3.脑内代谢物MI/Cr比值预测神经系统发育状况的能力最好。4.在5个感兴趣区(额叶、基底节、海马、脑室周围、小脑)中,基底节预测神经系统发育状况的能力最好。5.纠正6月和纠正1岁相比较,能够预测的最佳时间点可能为纠正1岁。
[Abstract]:Objective: to detect the level of metabolites in the brain in preterm infants by magnetic resonance spectroscopy (MRI), and explore (1) whether the metabolites in the brain can predict the development of the nervous system; (2) how many kinds of intracerebral metabolites can predict the development of the nervous system; (3) which of the intracerebral metabolites to predict the development of the nervous system is the best; (4) which (4) The ability of a region of intra brain metabolites to predict the development of the nervous system is best; (5) the best time points that can be predicted. Methods: 1. pairs of preterm infants underwent MRI and MRS scan.2. for the correction of the term, and the AIMS assessment and GESELL assessment were performed at the correction of June and the correction of 1 years. Results: the classification changes in 1. general data Volume (sex, fetal number, premature rupture of fetal membrane, prenatal hormone use, delayed sepsis, intraventricular hemorrhage, periventricular hemorrhage, periventricular softening, mother's occupational condition, mother education, patent ductus arteriosus, postpartum steroid use, brainstem evoked potential, test tube infants, asphyxia, hypoxic-ischemic encephalopathy, hyperbilirubinemia, intrauterine Infection, pregnancy induced hypertension, dystocia, premonitory abortion) and outcome variables (correction of the June AIMS score, developmental quotient, correction of 1 year old AIMS score, developmental quotient) were found to have a negative correlation between the periventricular softening and the correction of the June AIMS score (P0.05), the higher the degree of white plasma softening around the ventricle, the lower the June AIMS score; around the ventricles of the brain. White plasma softening was negatively correlated with the correction of 1 year old developmental quotient (P0.05), that is, the higher the degree of cerebral softening around the ventricle, the lower the 1 year old development business, the degree of asphyxia was negatively correlated with the correction of the 1 year old AIMS score and the correction of the 1 year old development quotient (P0.05), that is, the more severe the asphyxia degree, the correction of the 1 year old AIMS score, and the correction of the lower 1 year development business, and the degree of asphyxia and correction of social interaction in June. Negative correlation (P0.05), that is, the more severe the degree of asphyxia, the lower the score of social behavior in June. The degree of asphyxia is negatively related to correcting 1 year old movements and correcting 1 years of social behavior (P0.05), that is, the more severe the degree of asphyxia, the correction of 1 year old movements, and the correction of the lower.2. general data of 1 years of social behavior (gestational, birth weight, 1). Minute Apgar score, 5 minute Apgar score, auxiliary ventilation days, oxygen therapy days, hospital days, birth head circumference, birth length) and outcome variables (correct June AIMS score, developmental quotient, correct 1 year old AIMS score, developmental quotient), Pearson correlation analysis found that the number of auxiliary ventilation days was negatively correlated with the correction of 1 year old AIMS score (P0.05), that is auxiliary (P0.05). The more the number of days of aid ventilation, the lower the score of correcting the 1 year old AIMS; the pregnancy week was positively correlated with the correction of the June big movement (P0.05), that is, the greater the gestational week, the higher the score of the major movement in June; the more the pregnancy week and the correction of the adaptability of the 1 year old (P0.05), that is, the greater the gestational age, the higher the 1 year old adaptive score higher in the general data (birth weight, asphyxia degree). The single factor chi square analysis of neonatal hypoxic-ischemic encephalopathy, hyperbilirubinemia, intracranial hemorrhage, intrauterine infection, pregnancy induced hypertension, dystocia, threatened abortion) and outcome variables (cerebral palsy) found no statistically significant difference. P0.05.4. frontal lobe metabolites (NAA, Cho, Cr, MI, Lac, NAA/Cr, Cho/Cr, MI/Cr, Lac/Cr) were respectively with the outcome variables (corrected for AIMS in June). Pearson correlation analysis of the 1 year old AIMS score and the developmental quotient found that the differences were not statistically significant. The P0.05.5. basal ganglia metabolites (NAA, Cho, Cr, MI, Lac, NAA/Cr, Cho/Cr, MI/Cr, Lac/Cr) were respectively analyzed with the outcome variables (correcting the June score, the developmental quotient, the correction of the 1 year old score, the developmental quotient). MI concentration was negatively correlated with the correction of 1 years old development quotient (P0.05), that is, the higher the concentration of basal ganglia MI, the lower the 1 year old development business, the basal ganglia MI concentration is negatively correlated with the correction of 1 year old movement, fine movement, adaptability and social behavior (P0.05), that is, the higher the concentration of basal ganglia MI, the correction of 1 year old movements, the lower the score of fine movement, adaptability, social behavior. The ratio of Cho/Cr in the basal ganglia was negatively correlated with the fine movement of 1 years old (P0.05). That is, the greater the ratio of basal ganglia Cho/Cr, the lower the score of correcting 1 year old fine movements; the basal ganglia MI/Cr ratio was negatively correlated with the correction of 1 year old movements, fine movements, adaptability, language and social behavior (P0.05), that is, the greater the ratio of basal ganglia MI/Cr, the correction of 1 year old movements, fine movements, The lower.6. hippocampal metabolites (NAA, Cho, Cr, MI, Lac, NAA/Cr, Cho/Cr, MI/Cr, Lac/Cr) in adaptive, language, and social behavior with the outcome variables (correction of the June AIMS score, the developmental quotient, the 1 year old AIMS score, the developmental quotient) and the correlation analysis, the hippocampal region was negatively correlated with the correction of the June developmental quotient, namely the hippocampus The higher the Lac/Cr ratio, the lower the development of the June, the NAA/Cr ratio in the hippocampus was positively correlated with the correction of the big movement in June (P0.05), that is, the higher the NAA/Cr ratio in the hippocampus, the higher the score of the June big action. The MI concentration in the hippocampus is negatively correlated with the adaptation to the adaptability of the 1 year old (P0.05), that is, the higher the concentration of the hippocampal MI, the lower the adaptability score of the hippocampus is the lower.7. ventricle. The peripheral metabolites (NAA, Cho, Cr, MI, Lac, NAA/Cr, Cho/Cr, MI/Cr, Lac/Cr) were respectively associated with the outcome variables (correction of the June AIMS score, the developmental quotient, the correction of the 1 year old AIMS score, the developmental quotient) and the Pearson correlation analysis found that the concentration around the ventricle was negatively correlated with the correction of the 1 year old development quotient, that is, the higher the concentration around the ventricle, the lower the 1 year old development. The Lac/Cr ratio around the ventricle was negatively correlated with correcting the 1 year old AIMS score and correcting the 1 year old developmental quotient (P0.05), that is, the higher the Lac/Cr ratio around the ventricle, the correction of the 1 year old AIMS score and the correction of the lower 1 year development business, and the negative correlation between the concentration of Lac around the ventricle and the correction of the 1 year old movement (P0.05), that is, the higher the concentration of Lac around the ventricle, the correction of 1 year old movements, semen, The lower the fine movement score, the MI/Cr ratio around the ventricle was negatively correlated with the correction of the 1 year old movement (P0.05), the greater the MI/Cr ratio around the ventricle, the lower the score for correcting the 1 year old movement; the Lac/Cr ratio around the ventricle was negatively correlated with the correction of the 1 year old movement and the fine movement (P0.05), the greater the Lac/Cr ratio around the ventricle, the correction of the 1 year old movement and fine movement. The lower.8.'s cerebellar metabolites (NAA, Cho, Cr, MI, Lac, NAA/Cr, Cho/Cr, MI/Cr, Lac/Cr) with the outcome variables (correction of the June AIMS score, the developmental quotient, the 1 year old AIMS score, the developmental quotient) found that the cerebellar concentration was negatively correlated with the correction of the 1 year old hair maker, that is, the higher the concentration of cerebellum, the lower the 1 year old development business is lower. The Lac/Cr ratio of cerebellum was negatively correlated with the 1 year old developmental quotient (P0.05), that is, the higher the Lac/Cr ratio of the cerebellum, the higher the Lac/Cr ratio of the cerebellum, the lower the 1 year old development business, and the negative correlation between the cerebellar Lac/Cr ratio and the correction of the 1 year old movement (P0.05), that is, the higher the Lac/Cr ratio of the cerebellum, the lower the.9. multifactor regression analysis is the lower the score of the correction of the 1 year old movement: the single factor (general data, each sensation) After the Pearson related analysis of the June AIMS score, the developmental quotient, the 1 year old AIMS score and the developmental quotient, the statistically significant variables were analyzed as the independent variable, the outcome variable (correction of the June AIMS score, the developmental quotient, the correction of the 1 year old AIMS score, the developmental quotient) as the dependent variable for multiple linear regression It was found that preterm infants corrected the June developmental quotient, the influencing factors of fine movements were the Lac/Cr ratio in the hippocampus, and the factors affecting the score of 1 year old AIMS in premature infants were the degree of asphyxia and the number of auxiliary ventilation days, and the factors affecting the 1 year old developmental quotient in preterm infants were the basal ganglia MI/Cr ratio, the concentration of Lac around the ventricle, the periventricular softening, the cerebellar Lac/ Cr ratio; the influence factors of premature infants to correct 1 year old movements, fine movements, adaptability, language and social behavior are basal ganglia MI concentration, basal ganglia MI/Cr ratio, basal ganglia MI/Cr ratio, basal ganglia MI/Cr ratio, basal ganglia MI/Cr ratio. Conclusion: the level of intracellular metabolites in 1. preterm infants is helpful to predict the nervous system development of.2. brain. MI concentration of metabolites, Lac concentration, NAA/Cr ratio, Cho/Cr ratio, MI/Cr ratio, Lac/Cr ratio help predict the ability of.3. brain metabolite MI/Cr ratio to predict the nervous system development in.3. best.4. in 5 regions of interest (frontal lobe, basal ganglia, sea horse, periventricle, cerebellum), and basal ganglia predict nervous system development The best way to correct.5. is to rectify June and correct the age of 1. The best time to predict is 1.

【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R722.6

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