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目的以磁共振成像(MRI)提供的影像学资料为依据,评价早产儿脑白质损伤的早期MRI变化及其临床意义,并探讨其高危因素。方法选取2007年9月至2009年9月中国医科大学附属盛京医院儿科收治的262例早产儿,全部在7d内完成磁共振检查,根据MRI诊断早产儿脑白质损伤,分为病例组134例,对照组128例。并对病例组29例患儿进行二次复查。结果 (1)早产儿脑白质损伤早期,局灶性病变表现弥散加权成像(DWI)高信号,T1加权(T1WI)信号正常或稍高信号,伴有或不伴有T2加权(T2WI)低信号;弥漫性脑白质损伤仅能看到DWI弥漫性高信号,常规MRI无信号改变。复查结果,局灶性病变有两种情况:一是病灶消失,二是DWI高信号消失或稍高信号,T1WI高信号,伴或不伴有T2WI低信号;弥漫性病变,发生脑室周围白质软化,表现为T2WI高信号或高低混杂信号,DWI异常信号消失或高低混杂信号,T1WI高低混杂信号。(2)病例组与对照组在胎龄,出生体重差异无统计学意义。单因素分析:母孕期感染、双胎、代谢性酸中毒、低钙、低氧、机械通气和感染与早产儿早期脑白质损伤有统计学意义。Logistic模型多因素分析,母孕期感染、低氧和胎儿宫内窘迫是早产儿早期脑白质损伤的危险因素。结论 (1)DWI能发现早期脑白质损伤病变。(2)早产儿脑白质损伤是多种因素相互作用的结果:母孕期感染、胎儿宫内窘迫及出生后低氧与早产儿早期脑白质损伤有密切关系。(3)早产儿脑白质损伤早期临床表现缺乏特异性,建议常规行头MRI检查,且脑白质信号异常均需要动态随访观察。
Objective To evaluate the early MRI changes of white matter damage in preterm infants and its clinical significance on the basis of imaging data provided by magnetic resonance imaging (MRI) and to explore the risk factors. Methods A total of 262 preterm infants admitted to Shengjing Hospital Affiliated to China Medical University from September 2007 to September 2009 were recruited. All of them were examined by magnetic resonance imaging (MRI) within 7 days. MRI was used to diagnose white matter damage in preterm infants and divided into 134 cases , Control group of 128 cases. And 29 cases of patients with secondary review. Results (1) In the early stage of precentral white matter injury, focal lesion showed DWI high signal, T1 weighted (T1WI) signal normal or slightly high signal, with or without T2 weighted low signal ; Diffuse white matter injury can only see DWI diffuse high signal, conventional MRI no signal change. The review results, there are two cases of focal lesions: First, the lesions disappear, and second, DWI high signal disappeared or slightly higher signal, T1WI high signal, with or without T2WI low signal; diffuse lesions occur around the periventricular white matter softening , Manifested as T2WI high signal or high mixed signal, DWI abnormal signal disappears or high and low mixed signal, T1WI high and low mixed signal. (2) There was no significant difference in gestational age and birth weight between case group and control group. Univariate analysis showed that there were significant differences in the risk of white matter damage in the early stage of preterm infants in the first trimester of pregnancy, such as infection during pregnancy, twins, metabolic acidosis, hypocalcemia, hypoxia, mechanical ventilation and infection. Logistic model multivariate analysis, maternal infection, hypoxemia and fetal distress were risk factors for early white matter damage in preterm infants. Conclusion (1) DWI can detect early lesions of white matter lesions. (2) The white matter damage in preterm infants is the result of the interaction of many factors: infection during pregnancy, fetal distress and postnatal hypoxia are closely related to early white matter damage in premature infants. (3) The early clinical manifestations of white matter damage in preterm infants lack of specificity, it is recommended routine line head MRI, and white matter signal abnormalities need dynamic follow-up observation.