应用动脉自旋标记成像技术探讨胎儿窘迫对极早产儿脑血流灌注的影响  

Effect of fetal distress on cerebral blood flow perfusion of very preterm infants observed by using arterial spin labeling imaging technique

作　　者：薛倩茹 秦璠玥 张晨[1] 孔祥博 薛艳然 郭笑婵 徐发林[1] Xue Qianru;Qin Fanyue;Zhang Chen;Kong Xiangbo;Xue Yanran;Guo Xiaochan;Xu Falin(Department of Neonatology,the Third Affiliated Hospital of Zhengzhou University,Henan,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院新生儿科,河南郑州450052

出　　处：《发育医学电子杂志》2024年第4期263-270,共8页Journal of Developmental Medicine (Electronic Version)

基　　金：河南省儿科疾病临床医学研究中心开放课题(KFKT2021103)。

摘　　要：目的应用动脉自旋标记(arterial spin labeling,ASL)成像技术评估存在胎儿窘迫的极早产儿出生后脑血流灌注情况。方法采用前瞻性队列研究方法,选取2021年8月至2023年4月于郑州大学第三附属医院新生儿科住院治疗的53例极早产儿作为研究对象,根据是否存在胎儿窘迫分为窘迫组(n=22)和非窘迫组(n=31),分析两组患儿脑组织不同感兴趣区域脑血流差异,通过多元线性回归分析探讨胎儿窘迫与脑血流变化的相关性。统计学方法采用t检验或校正t检验、Mann-Whitney U检验、χ^(2)检验或Fisher确切概率法。结果窘迫组的单胎比例高于非窘迫组[81.8%(18/22)与54.8%(17/31),χ^(2)=4.176,P<0.05]。两组极早产儿在双侧额叶[左侧:23.9(21.7,28.0)ml/(100 g·min)与21.5(18.2,23.8)ml/(100 g·min),t=-2.826;右侧:(24.5±0.9)ml/(100 g·min)与(21.2±0.8)ml/(100 g·min),t=2.773]、双侧颞叶[左侧:(22.8±0.9)ml/(100 g·min)与(19.8±0.6)ml/(100 g·min),t=2.834;右侧:(23.2±0.9)ml/(100 g·min)与(20.8±0.7)ml/(100 g·min),t=2.108]、双侧顶叶[左侧:(24.0±1.1)ml/(100 g·min)与(19.4±0.8)ml/(100 g·min),t=3.377;右侧:25.6(18.9,28.1)ml/(100 g·min)与19.6(16.3,22.5)ml/(100 g·min),t=-2.311]、双侧枕叶[左侧:(25.7±1.4)ml/(100 g·min)与(21.2±0.9)ml/(100 g·min),t=2.796;右侧:(26.3±1.6)ml/(100 g·min)与(21.7±1.0)ml/(100 g·min),t=2.583]、双侧基底节[左侧:(35.4±1.5)ml/(100 g·min)与(29.0±0.8)ml/(100 g·min),t'=3.872;右侧:(34.9±1.4)ml/(100 g·min)与(29.3±1.0)ml/(100 g·min),t=3.457]、双侧丘脑[左侧:(40.0±2.0)ml/(100 g·min)与(35.0±1.3)ml/(100 g·min),t=2.157;右侧:(40.5±1.7)ml/(100 g·min)与(35.1±1.1)ml/(100 g·min),t=2.783]的脑血流量(cerebral blood flow,CBF)的比较中,窘迫组高于非窘迫组(P值均<0.05)。采用多元线性回归模型控制混杂因素(单胎、出生体质量、出生胎龄、纠正胎龄、性别、ASL成像技术检查时最近一次红细胞压积、辅助通气时间、前置胎盘、胎盘早剥、脐带�Objective To evaluate the effect of cerebral blood flow perfusion in very preterm infants with fetal distress by arterial spin labeling(ASL)imaging technique.Method Using a prospective cohort study method,a total of 53 very preterm infants who were born and hospitalized in the Department of Neonatology,the Third Affiliated Hospital of Zhengzhou University from August 2021 to April 2023 were selected as the research objects.According to the presence or absence of fetal distress,they were divided into distress group(n=22)and non-distress group(n=31).The differences in cerebral blood flow in different regions of interest of brain tissue between the two groups were analyzed.The correlation between fetal distress and cerebral blood flow changes was analyzed by multiple linear regression analysis.Independent sample t-test or correction t-test,Mann-Whitney U test andχ^(2) test or Fisher exact probability methodwere used for statistical analysis.Result The proportion of singletons was significantly higher in the distress group than in the non-distress group[81.8%(18/22)vs 54.8%(17/31),χ^(2)=4.176,P<0.05].In the very preterm infants,the cerebral blood flow(CBF)in the bilateral frontal lobes[left:23.9(21.7,28.0)ml/(100 g·min)vs 21.5(18.2,23.8)ml/(100 g·min),t=-2.826;right:(24.5±0.9)ml/(100 g·min)vs(21.2±0.8)ml/(100 g·min),t=2.773],bilateral temporal lobes[left:(22.8±0.9)ml/(100 g·min)vs(19.8±0.6)ml/(100 g·min),t=2.834;right:(23.2±0.9)ml/(100 g·min)vs(20.8±0.7)ml/(100 g·min),t=2.108],bilateral parietal lobes[left:(24.0±1.1)ml/(100 g·min)vs(19.4±0.8)ml/(100 g·min),t=3.377;right:25.6(18.9,28.1)ml/(100 g·min)vs 19.6(16.3,22.5)ml/(100 g·min),t=-2.311],bilateral occipital lobes[left:(25.7±1.4)ml/(100 g·min)vs(21.2±0.9)ml/(100 g·min),t=2.796;right:(26.3±1.6)ml/(100 g·min)vs(21.7±1.0)ml/(100 g·min),t=2.583],bilateral basal ganglia[left:(35.4±1.5)ml/(100 g·min)vs(29.0±0.8)ml/(100 g·min),t'=3.872;right:(34.9±1.4)ml/(100 g·min)vs(29.3±1.0)ml/(100 g·min),t=3.457],and bilateral thalami[left:(40.0±

关 键 词：胎儿窘迫 脑血流灌注 磁共振 动脉自旋标记成像技术 早产儿 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.5[医药卫生—诊断学]