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

张晓丽; 刘彦超; 夏磊; 徐发林

doi:10.7499/j.issn.1008-8830.2106005

PDF(630 KB)

HTML

中国当代儿科杂志 ›› 2021, Vol. 23 ›› Issue (9) : 916-921. DOI: 10.7499/j.issn.1008-8830.2106005

论著·临床研究

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

张晓丽¹, 刘彦超², 夏磊¹, 徐发林¹

作者信息 +

Role of Neonatal Behavioral Neurological Assessment combined with magnetic resonance diffusion tensor imaging in evaluating white matter development in preterm infants

ZHANG Xiao-Li, LIU Yan-Chao, XIA Lei, XU Fa-Lin

Author information +

文章历史 +

摘要

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月至2020年1月生后24 h内入住郑州大学第三附属医院新生儿重症监护室的98例早产儿为研究对象，根据NBNA结果分为异常组（<37分，51例）与正常组（≥37分，47例），采集两组早产儿10个感兴趣区的FA值，比较两组间的差异，并分析FA值及脐动脉血气pH值与NBNA结果的相关性。结果异常组内囊后肢FA值、脐动脉血pH值低于正常组（P<0.05）。内囊后肢FA值、脐动脉血pH与NBNA评分呈正相关（分别r_s=0.584、0.604，P<0.001）；内囊后肢FA值与脐动脉血pH呈正相关（r_s=0.426，P<0.05）。结论早产儿内囊后肢的FA值能定量反映脑白质发育情况，其与NBNA评分具有相关性，二者结合能够更准确、更客观评价早产儿脑白质发育情况。引用格式:

Abstract

Objective To study the correlation of fractional anisotropy (FA) on magnetic resonance diffusion tensor imaging with Neonatal Behavioral Neurological Assessment (NBNA) score in preterm infants, and to study the role of FA in evaluating white matter development from the perspective of imaging. Methods A prospective study was performed for 98 preterm infants who were admitted to the Neonatal Intensive Care Unit of the Third Affiliated Hospital of Zhengzhou University within 24 hours after birth from October 2016 to January 2020. According to the results of NBNA, they were divided into an abnormal group with 51 infants (NBNA score <37) and a normal group with 47 infants (NBNA score ≥37). The FA values of 10 regions of interest were collected and compared between the two groups. The correlations of FA value and umbilical arterial blood gas pH value with the NBNA score were analyzed. Results Compared with the normal group, the abnormal group had significantly lower FA value of the posterior limb of the internal capsule and umbilical arterial blood pH (P<0.05). The FA value of the posterior limb of the internal capsule and umbilical arterial blood pH were positively correlated with the NBNA score (r=0.584 and 0.604 respectively, P<0.001), and the FA value of the posterior limb of the internal capsule was positively correlated with umbilical arterial blood pH (r=0.426, P<0.05). Conclusions The FA value of the posterior limb of the internal capsule can quantitatively reflect white matter development in preterm infants and is correlated with the NBNA score. The combination of the two indices can help to evaluate white matter development in preterm infants more accurately and objectively. Citation:

导出引用

张晓丽, 刘彦超, 夏磊, 徐发林. 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[J]. 中国当代儿科杂志. 2021, 23(9): 916-921 https://doi.org/10.7499/j.issn.1008-8830.2106005

ZHANG Xiao-Li, LIU Yan-Chao, XIA Lei, XU Fa-Lin. Role of Neonatal Behavioral Neurological Assessment combined with magnetic resonance diffusion tensor imaging in evaluating white matter development in preterm infants[J]. Chinese Journal of Contemporary Pediatrics. 2021, 23(9): 916-921 https://doi.org/10.7499/j.issn.1008-8830.2106005

参考文献

1 Stoll BJ, Hansen NI, Bell EF, et al. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012[J]. JAMA, 2015, 314(10): 1039-1051. PMID: 26348753. PMCID: PMC4787615. DOI: 10.1001/jama.2015.10244.
2 Barton SK, Tolcos M, Miller SL, et al. Unraveling the links between the initiation of ventilation and brain injury in preterm infants[J]. Front Pediatr, 2015, 3: 97. PMID: 26618148. PMCID: PMC4639621. DOI: 10.3389/fped.2015.00097.
3 江苏省新生儿脑损伤规范化诊疗研究协作组. 江苏省早产儿脑损伤多中心临床流行病学调查[J]. 临床儿科杂志, 2019, 37(1): 6-10. DOI: 10.3969/j.issn.1000-3606.2019.01.002.
4 邢珊, 刘俐, 李改莲, 等. NBNA评分在评价早产儿脑发育、脑损伤及预后中的应用[J]. 中国儿童保健杂志, 2016, 24(2): 191-194. DOI: 10.11852/zgetbjzz2016-24-02-24.
5 李艳, 杜奕, 陈志强, 等. 缺氧缺血性脑病患儿表观扩散系数与行为神经测定评分的相关性研究[J]. 中华放射学杂志, 2015, 49(2): 133-137. DOI: 10.3760/cma.j.issn.1005-1201.2015.02.013.
6 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 5版. 北京: 人民卫生出版社, 2019.
7 鲍秀兰. 0~3岁儿童最佳的人生开端[M]. 北京: 中国发展出版社, 2005: 329-341.
8 Papile LA, Burstein J, Burstein R, et al. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm[J]. J Pediatr, 1978, 92(4): 529-534. PMID: 305471. DOI: 10.1016/s0022-3476(78)80282-0.
9 Wagenaar N, Chau V, Groenendaal F, et al. Clinical risk factors for punctate white matter lesions on early magnetic resonance imaging in preterm newborns[J]. J Pediatr, 2017, 182: 34-40.e1. PMID: 28063691. DOI: 10.1016/j.jpeds.2016.11.073.
10 王飞, 刘亚辉, 黄婷婷. PVL脑瘫患儿MRI分级与粗大运动功能分级的相关性分析[J]. 医学影像学杂志, 2019, 29(5): 721-725.
11 吴卫红, 鲍秀兰, 席冰玉, 等. 0～1岁52项神经运动检查和简化20项相关性研究[J]. 中国儿童保健杂志, 2014, 22(3): 310-312.
12 邢珊, 孙慧清. NBNA评分与TMS评分在评价早产儿脑发育及脑损伤中的作用及相关性分析[J]. 河南医学研究, 2018, 27(8): 1393-1394. DOI: 10.3969/j.issn.1004-437X.2018.08.016.
13 Merhar SL, Gozdas E, Tkach JA, et al. Neonatal functional and structural connectivity are associated with cerebral palsy at two years of age[J]. Am J Perinatol, 2020, 37(2): 137-145. PMID: 30919395. PMCID: PMC8103821. DOI: 10.1055/s-0039-1683874.
14 Rose J, Butler EE, Lamont LE, et al. Neonatal brain structure on MRI and diffusion tensor imaging, sex, and neurodevelopment in very-low-birthweight preterm children[J]. Dev Med Child Neurol, 2008, 51(7): 526-535. PMID: 19459915. DOI: 10.1111/j.1469-8749.2008.03231.x.
15 刘骁, 毛健, 李娟, 等. 早产儿微小型脑白质损伤的MRI-DTI评价[J]. 中国当代儿科杂志, 2015, 17(6): 554-559. PMID: 26108312. DOI: 10.7499/j.issn.1008-8830.2015.06.004.
16 穆靓, 杨健, 鱼博浪. 磁共振弥散加权及张量技术在新生儿缺血缺氧性脑病中的应用[J]. 磁共振成像, 2010, 1(1): 60-64. DOI: 10.3969/j.issn.1674-8034.2010.01.015.
17 Pieterman K, Plaisier A, Govaert P, et al. Data quality in diffusion tensor imaging studies of the preterm brain: a systematic review[J]. Pediatr Radiol, 2015, 45(9): 1372-1381. PMID: 25820411. DOI: 10.1007/s00247-015-3307-y.
18 Arzoumanian Y, Mirmiran M, Barnes PD, et al. Diffusion tensor brain imaging findings at term-equivalent age may predict neurologic abnormalities in low birth weight preterm infants[J]. AJNR Am J Neuroradiol, 2003, 24(8): 1646-1653. PMID: 13679287. PMCID: PMC7974006.
19 王燕彬, 张惠荣, 潘金勇, 等. 热休克蛋白70和NBNA评分与新生儿窒息的相关性研究[J]. 中华新生儿科杂志(中英文), 2017, 32(1): 35-38. DOI: 10.3969/j.issn.2096-2932.2017.01.009.
20 Duerden EG, Foong J, Chau V, et al. Tract-based spatial statistics in preterm-born neonates predicts cognitive and motor outcomes at 18 months[J]. AJNR Am J Neuroradiol, 2015, 36(8): 1565-1571. PMID: 25929880. PMCID: PMC7964703. DOI: 10.3174/ajnr.A4312.
21 Maurya VK, Ravikumar R, Bhatia M, et al. Hypoxic-ischemic brain injury in an adult: magnetic resonance imaging findings[J]. Med J Armed Forces India, 2016, 72(1): 75-77. PMID: 26900228. PMCID: PMC4723704. DOI: 10.1016/j.mjafi.2015.06.016.
22 Sabol BA, Caughey AB. Acidemia in neonates with a 5-minute Apgar score of 7 or greater—what are the outcomes?[J]. Am J Obstet Gynecol, 2016, 215(4): 486.e1-486.e6. PMID: 27255470. DOI: 10.1016/j.ajog.2016.05.035.
23 中华医学会围产医学分会新生儿复苏学组. 新生儿脐动脉血气分析临床应用专家共识(2021)[J]. 中华围产医学杂志, 2021, 24(6): 401-405. DOI: 10.3760/cma.j.cn113903-20210413-00346.