目的 探讨坏死性小肠结肠炎（necrotizing enterocolitis, NEC）早产儿发生脑白质损伤（white matter damage, WMD）的高危因素。 方法 回顾性分析2021年1月—2023年12月复旦大学附属儿科医院收治的249例NEC早产儿病例资料。根据头颅磁共振成像脑白质评分将患儿分为WMD组（≥7分）和非损伤组（<7分），采用多因素logistic回归分析探讨NEC早产儿WMD危险因素。 结果 通过组间分析比较，发现WMD组患儿在革兰氏阴性菌感染率（43.1% vs 28.2%）、外科治疗比例（47.2% vs 23.2%）、视频脑电图（video electroencephalography, VEEG）中重度异常率（51.4% vs 11.9%）等方面显著高于非损伤组（均P<0.05）。多因素logistic回归分析显示，外科治疗（OR=1.822，95%CI：1.199~2.777）、住院时间延长（OR=1.041，95%CI：1.004~1.080）及VEEG中重度异常（OR=7.045，95%CI：3.349~14.855）是WMD的独立危险因素（均P<0.05）。 结论 外科治疗、住院时间延长及VEEG显示中重度异常是NEC早产儿并发WMD的独立危险因素。为临床早期识别和干预提供依据，以改善患儿神经预后。
Objective To investigate the risk factors for white matter damage (WMD) in preterm infants with necrotizing enterocolitis (NEC). Methods A retrospective analysis was conducted on the clinical data of 249 preterm infants with NEC admitted to Children's Hospital of Fudan University between January 2021 and December 2023. Based on brain magnetic resonance imaging (MRI) white matter scores, the infants were categorized into a WMD group (≥7 points) and a non-injury group (<7 points). A multivariable logistic regression analysis was performed to identify risk factors for WMD. Results Compared with the non-injury group, the WMD group had significantly higher rates of Gram-negative bacterial infection (43.1% vs 28.2%), surgical treatment (47.2% vs 23.2%), and moderate-to-severe abnormalities on video electroencephalography (VEEG) (51.4% vs 11.9%) (all P<0.05). The multivariable logistic regression analysis showed that surgical treatment (OR=1.822, 95%CI: 1.199-2.777), longer hospital stay (OR=1.041, 95%CI: 1.004-1.080), and moderate-to-severe VEEG abnormalities (OR=7.045, 95%CI: 3.349-14.855) were independent risk factors for WMD (all P<0.05). Conclusions Surgical treatment, prolonged hospitalization, and moderate-to-severe VEEG abnormalities are independent risk factors for WMD in preterm infants with NEC, providing a basis for early clinical identification and intervention to improve neurological outcomes.
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