新生儿局灶性脑白质损伤对患儿远期神经功能影响的随访观察  

Follow-up Observation on the Effects of Neonatal Punctate White Matter Lesions on the Long-term Neurological Function of Children

作　　者：吴蓉 何莲 贺雨欣 张高峰 WU Rong;HE Lian;HE Yuxin;ZHANG Gaofeng(Department of Radiology,the Second Affiliated Hospital of Zunyi Medical University,Zunyi 563000,China;不详)

机构地区：[1]遵义医科大学第二附属医院医学影像科,贵州遵义563000 [2]遵义医科大学第三附属医院医学影像科,贵州遵义563003

出　　处：《中国医学创新》2024年第35期141-145,共5页Medical Innovation of China

基　　金：贵州省卫生健康委科学技术基金项目(gzwjkj2020-1-177)。

摘　　要：目的:探讨局灶性脑白质损伤对新生儿远期神经功能的影响。方法:回顾性纳入2012年1月—2013年6月出生于遵义医科大学附属医院的新生儿,于出生后3~7 d经临床确诊为缺氧缺血性脑病,且MRI检查示病灶位于视辐射或视中枢的局灶性脑白质损伤患儿33例作为观察组,另选取同期健康新生儿20例作为对照组,8年后对两组进行随访,以评估其神经功能和视觉功能的状况。结果:观察组初次MRI检查中,病灶位于视辐射或视中枢左侧9例(27.3%),右侧为11例(33.3%),双侧均发生为13例(39.4%);8年后随访观察组中有7例完成MRI检查,1例见左侧侧脑室枕角增大,1例右侧大脑少量变性灶,其余5例患儿MRI未见明显异常病灶。8年后随访,观察组与对照组视觉功能比较,差异无统计学意义(P>0.05),观察组韦氏儿童智力量表第五版(WISC-Ⅴ)评分为(96.97±10.66)分,低于对照组的(105.42±9.24)分,差异有统计学意义(t=-3.120,P=0.003);观察组病灶数量与视觉功能无相关性(P>0.05),与WISC-Ⅴ评分呈负相关(r_(s)=-0.499,P=0.003)。结论:视辐射或视中枢局灶性脑白质损伤不影响患儿视觉功能,可能影响患儿智力功能。Objective:To investigate the effect of punctate white matter lesions on neonatal long-term nerve function.Method:Thirty-three newborns born in the Affiliated Hospital of Zunyi Medical University from January 2012 to June 2013 who were clinically diagnosed with hypoxic-ischemic encephalopathy 3 to 7 days after birth and with punctate white matter lesions by MRI examination located in the optic radiation or optic center were selected as the observation group,and another 20 healthy newborns in the same period were selected as the control group.Both groups were followed up eight years later to assess neurological and visual function.Result:In the initial MRI examination of the observation group,9 cases(27.3%)had lesions located on the left side of the optic radiation or optic center,11 cases(33.3%)on the right side,and 13 cases(39.4%)had lesions on both sides.After 8 years of follow-up observation group,7 cases completed MRI examination,and 1 case saw enlargement of left lateral ventricle occipital angle,a small number of degenerative lesions were found in the right side of the brain in 1 case,the other 5 cases had no obvious abnormal lesions on MRI.After 8 years of follow-up,there was no statistically significant difference in visual function between the observation group and the control group(P>0.05).The Wechsler intelligence scale for children-Ⅴ(WISC-Ⅴ)score of the observation group was(96.97±10.66)points,which was lower than(105.42±9.24)points of the control group,the difference was statistically significant(t=-3.120,P=0.003).The number of lesions in the observation group was not correlated with visual function(P>0.05),but was negatively correlated with WISC-Ⅴscore(r_(s)=-0.499,P=0.003).Conclusion:Visual radiation or punctate white matter lesions in the visual center does not affect children's visual function,but may affect children's intellectual function.

关 键 词：新生儿 缺氧缺血性脑病 局灶性脑白质损伤 远期预后 

分 类 号：R722.1[医药卫生—儿科]