不同原因早产对极早产儿脑血流灌注的影响  

Effect of preterm birth with different causes on cerebral blood perfusion in very preterm infants

作　　者：薛倩茹 牛铭 程慧清[1] 马徜徉 张萌[1] 王彬[1] 徐发林[1] Xue Qianru;Niu Ming;Cheng Huiqing;Ma Changyang;Zhang Meng;Wang Bin;Xu Falin(Department of Neonatology,Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院新生儿科,郑州450052

出　　处：《中华围产医学杂志》2024年第9期756-761,共6页Chinese Journal of Perinatal Medicine

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

摘　　要：目的探讨不同原因早产与极早产儿不同感兴趣区脑血流灌注之间的可能关系。方法本研究为前瞻性队列研究。选择2022年4月至2023年5月生后24 h内转入郑州大学第三附属医院新生儿科的胎龄28~31周+6的145例早产儿为研究对象,根据早产原因分为医源性早产组(n=55)、胎膜早破自发早产组(n=47)和胎膜完整自发早产组(n=43)。利用动脉自旋标记技术测量各组极早产儿不同感兴趣区(额叶、颞叶、顶叶、枕叶等皮层及丘脑和基底节神经区深部灰质)脑血流值(cerebral blood flow,CBF)。采用单因素方差分析、Kruskal-Wallis H检验及Bonferroni校正、χ^(2)检验或Fisher精确概率法、协方差分析及LSD检验等比较各组CBF的差异。结果3组早产儿住院期间出现脑白质损伤、Ⅰ~Ⅱ级颅内出血、晚发型败血症等并发症的发生率差异均无统计学意义(P值均>0.05)。医源性早产组与胎膜早破自发早产组相比,CBF[单位ml/(100 g·min)]在右侧颞叶[20.5(16.1~24.6)与17.1(14.5~23.0)]、双侧顶叶[左侧:22.4(17.1~25.3)与16.9(14.4~24.1);右侧:23.0(18.2~27.4)与17.0(14.0~22.2)]、右侧枕叶[22.1(18.6~29.5)与19.4(13.7~24.5)]、双侧基底节[左侧:33.0(29.1~36.3)与24.9(22.9~33.1);右侧:32.8(29.0~37.0)与26.1(22.3~35.0)]、双侧丘脑[左侧:39.2(36.0~45.0)与32.6(25.1~42.2);右侧:38.6(34.6~44.1)与32.0(25.4~44.9)]等感兴趣区均较高(Bonferroni校正,P值均<0.017);医源性早产组与胎膜完整自发早产组相比,CBF在双侧额叶[左侧:21.4(18.3~25.3)与17.0(12.0~22.2);右侧:22.1(16.7~25.0)与15.9(12.0~23.3)]、颞叶[左侧:21.4(17.0~24.8)与18.4(14.0~22.0);右侧:20.5(16.1~24.6)与17.3(13.3~22.3)]、顶叶[左侧:22.4(17.1~25.3)与15.3(10.4~20.8);右侧:23.0(18.2~27.4)与15.7(11.1~23.6)]、枕叶[左侧:22.7(18.8~28.4)与18.2(11.4~23.4);右侧:22.1(18.6~29.5)与19.6(14.0~25.8)]、基底节[左侧:33.0(29.1~36.3)与27.7(19.1~32.4);右侧:32.8(29.0~37.0)与27.7(21.5~33.0)]及丘脑[左侧:39.2(36.0~45.0)与33.9(ObjectiveTo explore the relationship between preterm labor with different causes and cerebral perfusion in different regions of interest in very preterm infants.MethodsThis was a prospective cohort study.A total of 145 preterm infants with gestational age of 28-31+6 weeks who were hospitalized in the Neonatology Department of the Third Affiliated Hospital of Zhengzhou University within 24 h after birth from April 2022 to May 2023 were selected for the study,and were categorized into the iatrogenic preterm labor group(n=55),spontaneous preterm labor with premature rupture of the membranes(PROM)group(n=47),and spontaneous preterm labor with intact membranes group(n=43)according to the cause of preterm labor.Cerebral blood flow(CBF)values in the cortex and deep gray matter of different regions of interest(frontal lobe,temporal lobe,parietal lobe,occipital lobe,thalamus,and basal ganglia)were measured using the arterial spin labeling technique in the very preterm infants in each group.One-way analysis of variance,Kruskal-Wallis H test and Bonferroni correction,Chi-square test or Fisher's exact probability method,analysis of covariance,and LSD test were used to compare the differences in CBF among the groups.ResultsThe differences in the incidence of complications such as cerebral white matter injury,Ⅰ-Ⅱgrade intracranial hemorrhage,and late-onset sepsis during hospitalization among the three groups of preterm infants were not statistically significant(all P>0.05).In the iatrogenic preterm labor group,compared with the spontaneous preterm labor with PROM group,CBF[in units of ml/(100 g·min)]was higher in regions of interest such as the right temporal lobe[20.5(16.1-24.6)vs.17.1(14.5-23.0)],bilateral parietal lobe[left side:22.4(17.1-25.3)vs.16.9(14.4-24.1);right side:23.0(18.2-27.4)vs.17.0(14.0-22.2)],right occipital lobe[22.1(18.6-29.5)vs.19.4(13.7-24.5)],bilateral basal ganglia[left side:33.0(29.1-36.3)vs.24.9(22.9-33.1);right side:32.8(29.0-37.0)vs.26.1(22.3-35.0)],and bilateral thalamus[left side:39.2(36.0-45

关 键 词：医源性早产 脑血流 MRI动脉自旋标记成像技术 早产儿 

分 类 号：R722.6[医药卫生—儿科]