早产儿和足月儿脑性瘫痪的危险因素分析及磁共振弥散张量成像的比较

发布时间：2018-02-26 20:23

本文关键词： 脑性瘫痪早产儿足月儿危险因素弥散张量成像 FA值粗大运动功能　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的分析脑性瘫痪的危险因素,比较危险因素在早产儿脑瘫和足月儿脑瘫中分布的差异,为脑瘫的早期预防和诊断提供一定的依据。同时运用磁共振弥散张量成像技术中的白质纤维束的各向异性FA值和粗大运动功能评估量表中粗大运动功能分值,分别分析早产儿和足月儿脑瘫组两项指标之间的相关性,进而分析弥散张量成像在两组中应用价值。材料和方法选取2013年9月至2016年12月安徽省儿童医院康复科就诊的确诊为脑性瘫痪的儿童120例(早产48例、足月72例;男性88例、女性32例),进行脑瘫的危险因素分析;选择临床资料完整的病例入早产儿脑瘫组(32例:男性25例;女性7例)和足月儿脑瘫组(32例:男性25例;女性7例),进行磁共振弥撒张量成像应用价值的比较。危险因素的调查采用回顾性分析的方法,按照事先设计好的表格,依据危险因素的定义,查阅我院已归档的电子病历收集资料,部分信息不完整的病历电话询问家长完善资料。使用英国Rusell等人编制修订的GMFM-88项量表评估患儿的粗大运动功能(gross motor function measure,GMFM),量表共分为躺和翻身,坐位,爬与跪,站立位和行走、跑、跳5个功能区,评估由康复科高年资医师及治疗师操作、本人参与完成,最后通过GMFM的统计软件GMAE自动分析处理分别得出5个功能区得分比值和总分比值。磁共振检查采用安徽省儿童医院磁共振室的飞利浦Achieva 1.5T磁共振扫描仪完成头颅磁共振成像,磁共振平扫和弥散张量成像(diffusion tensor imaging,DTI),测量白质不同部位的部分各向异性(fractionalanisotropy,FA)值,感兴趣区(regions of interest,ROI)的选择依据是在解剖清晰明确的纤维束经过的区域,分别是内囊前肢(ICAL)、内囊膝部(ICG)、内囊后肢(ICPL)、胼胝体体部(BCC)、胼胝体膝部(GCC)、胼胝体压部(SCC)及皮质脊髓束(CST)。最后运用工作站自带的Service Pack 9软件处理获得数值,并在DTI图像上获得锥体束三维彩色示踪图。所有数据采用EXCEL2007和SPSS19.0软件进行统计和分析,定量数据的结果以均数±标准差(x±s)表示,用独立样本均数的t检验进行分析,定性资料运用检验,对不同部位FA值与GMFM值进行pearson相关分析,相关系数用r表示,所有统计以α=0.05为检验水准。结果(1)脑性瘫痪的危险因素出现的比率依次为:新生儿窒息、异常妊娠、早产、低出生体重、黄疸、缺氧缺血性脑病、新生儿感染、颅内出血、低血糖。早产儿组危险因素较高的依次为:低出生体重、新生儿窒息、异常妊娠、黄疸;足月儿组较高的为:新生儿窒息、异常妊娠。(2)两组比较,低出生体重、新生儿窒息、黄疸在两组中出现的比率的差异有统计学意义(P0.05),且均是早产儿组足月儿组;两种及两种以上危险因素在两组中出现的比率的差异也有统计意义(P0.001),早产儿组(97.9%)足月儿组(40.3%)。(3)120例患儿MRI平扫报告8例未见明显异常(8/120,6.67%),63例侧脑室旁白质软化(PVL)(63/120,52.5%),早产组39例,足月组24例,PVL在两组中出现的比率的差异有统计意义(P0.001),早产儿组(81.3%)足月组(33.3%)。(4)64例脑瘫患儿测定的FA值结果在空间不同部位上,胼胝体皮质脊髓束内囊后肢内囊膝部内囊前肢,在胼胝体部位的各向异性FA值压部体部膝部。早产儿脑瘫组和足月儿脑瘫组组内比较也符合此规律。(5)同一部位的FA值足月儿脑瘫高于早产儿脑瘫,在右侧内囊后肢、胼胝体压部和左、右侧皮质脊髓束部位足月儿和早产儿间存在统计学差异(P0.05)。早产儿和足月儿组内左右对称部位的FA值差异均无统计学意义(P0.05)(6)早产儿脑瘫组的FA值与GMFM-88分值在双侧内囊前肢、双侧内囊膝部、双侧内囊后肢和胼胝体膝部的相关性具有统计意义(P0.05),其中在左侧内囊后肢的相关的密切程度最高(r=0.616 P0.001),共有七个部位的相关性有统计意义;足月儿脑瘫组的FA值与GMFM-88分值仅在右侧内囊膝部的相关性有统计意义(P0.05),在右侧内囊膝部的相关系数r=0.411,小于早产儿脑瘫组在此部位的相关系数(r=0.474)。(7)综合评价内囊前肢、膝部、后肢、胼胝体和皮质脊髓束的FA值与GMFM-88分值的相关性,早产儿组内囊前肢、膝部和后肢与GMFM-88的相关有统计意义(P0.05),其中内囊后肢的相关密切程度最高(r=0.572 P=0.001),足月儿组五个部位的相关性均无统计意义(p≥0.05)。结论(1)脑性瘫痪较多见的危险因素有新生儿窒息、异常妊娠、早产、低出生体重、黄疸。(2)早产儿比足月儿更易发生PVL。(3)早产儿脑瘫比足月儿脑瘫更易出现两种及两种以上的本研究所设定的危险因素。(4)早产儿脑瘫比足月儿脑瘫更易合并低出生体重、新生儿窒息和黄疸等危险因素。(5)早产儿脑瘫的整体白质发育较足月儿脑瘫明显延迟。(6)早产儿脑瘫的FA值比足月儿脑瘫的FA值更能代表和反应患儿的运动功能,DTI在早产儿脑瘫中的应用价值比足月儿脑瘫高。(7)DTI检查中内囊后肢的FA值可作为早产儿脑损伤的评价及动态监测白质发育的一项指标。(8)DTI有着较广阔的应用空间,应用价值待挖掘和探索。
[Abstract]:Objective to analyze the risk factors of cerebral palsy, the difference in the distribution of risk factors of cerebral palsy of premature infants and full-term infants with cerebral palsy, provide a basis for prevention and early diagnosis of cerebral palsy. At the same time using the assessment of magnetic resonance diffusion tensor imaging of white matter fiber anisotropy FA values and gross motor function scale gross motor functional scores were analyzed in term and preterm infants with cerebral palsy group correlation between the two indexes, and then analyzes the application value of diffusion tensor imaging in two groups. Materials and methods from September 2013 to December 2016 in Anhui province children's hospital were diagnosed with cerebral palsy children in 120 cases (48 cases of premature delivery, 72 cases of full-term male; in 88 cases, female 32 cases), analysis of risk factors of cerebral palsy; clinical data of cases of cerebral palsy of premature infants (32 cases in group: 25 cases; 7 cases of male and female) and full-term infants brain Paralysis group (32 cases, 25 cases; 7 cases of male and female), compare the application value of diffusion tensor imaging. The risk factors were investigated by retrospective analysis method, according to the designed forms, according to the definition of risk factors, access to electronic medical records in our hospital have been archived data collection part information complete medical call ask parents perfectinformation. GMFM-88 scale assessment of children with gross motor function using British Rusell et al. Preparation of revised (gross motor function measure, GMFM), the scale is divided into lying and sitting, kneeling and turning, climbing, standing and walking, running, jumping 5 functional areas, evaluation operated by the Department of rehabilitation doctors and therapists high years, I had done, and finally through the GMFM statistical software GMAE automatic analysis were obtained in 5 functional areas and the ratio of total score. The ratio of magnetic resonance examination by the children's Hospital of Anhui province Co The vibration chamber of the PHILPS Achieva 1.5T MRI scanner to complete cranial magnetic resonance imaging, MRI and diffusion tensor imaging (diffusion tensor, imaging, DTI), fractional anisotropy measurements of white matter in different parts (fractionalanisotropy, FA), a region of interest (regions of, interest, ROI) on the selection is in clear anatomy the fibers pass through the region, which is the anterior limb of internal capsule (ICAL), genu and posterior limb of the internal capsule (ICG) (ICPL), corpus callosum (BCC), corpus callosum (GCC), splenium of corpus callosum (SCC) and corticospinal tract (CST). The last 9 software obtained by the workstation with Service Pack, and cone beam 3D color tractography on DTI images. All the data were collected and analyzed by EXCEL2007 and SPSS19.0 software, the results of quantitative data to mean + standard deviation (x + s) said, t test the number of independent samples Analysis of qualitative data using the test, the different parts of the FA value and GMFM value of Pearson correlation analysis, correlation coefficient r, all statistics to test the level of a =0.05. Results (1) the ratio of risk factors in children with cerebral palsy were: neonatal asphyxia, abnormal pregnancy, premature birth, low birth weight, jaundice, hypoxic ischemic encephalopathy, neonatal infection, intracranial hemorrhage, hypoglycemia in premature infants. High risk factors were as follows: low birth weight, neonatal asphyxia, abnormal pregnancy, jaundice of full-term infants; high: abnormal pregnancy and neonatal asphyxia,. (2) the two groups, low birth weight, neonatal asphyxia, was statistically significant the difference in the ratio of jaundice occurring in the two groups (P0.05), and are also the full-term infants in premature group; there was statistical difference ratio of two and more than two kinds of risk factors in the two group (P0.001), in the premature infant group (97.9% ) of full-term infants (40.3%). (3) in 120 cases with MRI scan 8 cases had no obvious abnormalities (8/120,6.67%), 63 cases of periventricular leukomalacia (PVL) (63/120,52.5%), preterm labor group 39 cases, 24 cases of full-term group, there were significant differences between the ratio of PVL in the two groups (the P0.001), preterm infants (81.3%) term group (33.3%). (4) of 64 cases of children with cerebral palsy FA measured results in different parts of the space, corpus callosum, corticospinal tract in the posterior limb of the internal capsule genu anterior limb of the internal capsule, pressing part body knee anisotropic FA values in the corpus callosum. Premature infants with cerebral palsy group and foot the cerebral palsy group compared with the law. (5) the same parts of the FA value is higher than that of full-term infants with cerebral palsy cerebral palsy of premature infants, in the right posterior limb of the internal capsule, corpus callosum and left, there was a statistically significant difference between the right parts of the corticospinal tract in term and preterm infants (P0.05). Between preterm and full-term children in symmetrical part The FA value had no significant difference (P0.05) (6) the value of FA in cerebral palsy of premature infants with GMFM-88 scores in the bilateral anterior limb of internal capsule, bilateral genu, with statistical significance of the correlation between the bilateral posterior and genu of the corpus callosum (P0.05), which in the left posterior limb of the internal capsule related closely to the highest degree (r=0.616 P0.001) a total of seven parts, the correlation has statistical significance; the value of FA in cerebral palsy infants with GMFM-88 scores only in the correlation of right internal capsule knee has statistical significance (P0.05), the correlation coefficient of r=0.411 right genu, the correlation coefficient is less than the group on the site of cerebral palsy of premature infants (r=0.474). (7) the comprehensive evaluation of internal capsule the forelimbs, hind legs, knees, correlation between GMFM-88 score and corpus callosum and corticospinal tract FA, premature group and hind knee anterior limb of the internal capsule, and GMFM-88 related statistical significance (P0.05), which is closely related to the posterior limb of the internal capsule The highest level (r=0.572 P=0.001), the correlation of full-term infants in five positions were no statistical significance (P = 0.05). Conclusion (1) cerebral palsy risk factors were more common in neonatal asphyxia, abnormal pregnancy, premature birth, low birth weight, premature infant jaundice. (2) more easily than full-term infants (3 PVL.) cerebral palsy of premature infants than in full-term infants with cerebral palsy is more prone to risk factors of two and more than two set by this research. (4) cerebral palsy of premature infants with low birth weight are more likely than full-term infants with cerebral palsy, asphyxia neonatorum and jaundice risk factors. (5) the overall development of the white matter of cerebral palsy of premature infants in full-term infants with cerebral palsy significantly delay. (6) the FA value of cerebral palsy of premature infants than in full-term infants with cerebral palsy FA better motor function in children with representative and reaction, the application value of DTI in cerebral palsy of premature infants than in full-term infants with cerebral palsy. (7) DTI in the posterior limb of the internal capsule FA value can be used as a brain injury in preterm infants And dynamic monitoring of the development of white matter. (8) DTI has a wider application space, and the application value should be excavated and explored.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.3

【参考文献】