磁共振成像及发育量表对脑瘫高危儿粗大运动发育的预测研究

关键词：脑性瘫痪  磁共振成像  发育量表  粗大运动发育  康复

Keywords:cerebral palsy  magnetic resonance imaging  developmental scale  gross motor development  rehabilitation

摘要：

      摘要 目的：分析并比较磁共振成像及发育量表对脑瘫高危儿粗大运动发育的预测作用。 方法：73例有早产背景的脑瘫高危儿，在纠正胎龄3月时行头颅MRI检查，定性评价脑白质异常(WMA)程度，并同期应用婴幼儿发育量表中的精神运动发育指数(PDI)分值评定整体运动情况，智力发育指数(MDI)分值评定智能水平。随访患儿坐位、立位平衡的完成时间，对WMA、PDI、MDI和坐位、立位平衡完成时间行相关性分析，并计算WMA、PDI、MDI对粗大运动延迟预测的敏感性和特异性。 结果：WMA、PDI、MDI和坐位、立位平衡的完成时间均有显著相关性，相关系数自高向低排序依次为WMA、PDI、MDI，三者结合与坐位、立位平衡完成时间的相关性进一步提高。WMA对坐位和立位发育延迟的预测敏感性及特异性均高于PDI及MDI。 结论：WMA程度、早期整体运动及智能水平均和粗大运动完成时间有显著相关性，MRI结合发育量表可提高对脑瘫高危儿粗大运动发育的预测价值。

Abstract:

      Abstract Objective: To explore and compare the predictive value of magnetic resonance imaging(MRI) and developmental scales for gross motor outcomes in infants at high risk for cerebral palsy. Method: Seventy-three high-risk preterm infants were examined with MRI to evaluate white matter abnormality (WMA) qualitatively at 3 months′ corrected age, and had psychomotor development index(PDI) and mental development index(MDI) measures to assess global motor performance and intelligence level at the same time. The time of performing sitting balance and standing balance were followed up, and the associations between early assessments of WMA,PDI,MDI and measurements of sitting balance time as well as standing balance time were analyzed. Sensitivity and specificity were calculated for WMA, PDI, MDI to predict sitting balance time and standing balance time. Result: Significant associations between WMA, PDI, MDI and sitting balance time, standing balance time were noted, precedence ordering of correlation coefficient were WMA, PDI, MDI from higher to lower level, and the combination of WMA, PDI and MDI led to greater correlation with sitting balance time and standing balance time. WMA demonstrated the greatest specificity and sensitivity in predicting sitting and standing development delay than PDI and MDI. Conclusion: The severity of WMA and level of early global motor performance and intelligence correlated with performed time of gross motor significantly. The combination of predictor assessments (MRI and developmental scales) could improve predictive validity for gross motor outcomes in infants at high risk for cerebral palsy.