本文選題：小于32周極低出生體重兒 + 磁共振波譜�。� 參考：《廣州醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:通過磁共振波譜成像技術(shù)檢測(cè)早產(chǎn)兒足月時(shí)的腦內(nèi)代謝物水平,探討:(1)腦內(nèi)代謝物能否預(yù)測(cè)神經(jīng)系統(tǒng)發(fā)育狀況;(2)有多少種腦內(nèi)代謝物能夠預(yù)測(cè)神經(jīng)系統(tǒng)發(fā)育狀況;(3)哪一種腦內(nèi)代謝物預(yù)測(cè)神經(jīng)系統(tǒng)發(fā)育狀況的能力最好;(4)哪一區(qū)域的腦內(nèi)代謝物預(yù)測(cè)神經(jīng)系統(tǒng)發(fā)育狀況的能力最好;(5)能夠預(yù)測(cè)的最佳時(shí)間點(diǎn)。方法:1.對(duì)入組的早產(chǎn)兒在糾正足月時(shí)行MRI平掃和MRS掃描。2.對(duì)入組的早產(chǎn)兒在糾正6月和糾正1歲時(shí)行AIMS評(píng)估和GESELL評(píng)估。結(jié)果:1.一般資料中的分類變量(性別、胎數(shù)、未足月胎膜早破、出生前激素使用、遲發(fā)敗血癥、腦室內(nèi)出血、腦室周圍白質(zhì)軟化、母親職業(yè)情況、母親教育情況、動(dòng)脈導(dǎo)管未閉、產(chǎn)后類固醇使用、腦干誘發(fā)電位、試管嬰兒、窒息程度、新生兒缺氧缺血性腦病、高膽紅素血癥、宮內(nèi)感染、妊高癥、難產(chǎn)、先兆流產(chǎn))分別與結(jié)局變量(糾正6月AIMS得分、發(fā)育商;糾正1歲AIMS得分、發(fā)育商)進(jìn)行pearson相關(guān)分析發(fā)現(xiàn),腦室周圍白質(zhì)軟化與糾正6月AIMS得分呈負(fù)相關(guān)(P0.05),即腦室周圍白質(zhì)軟化程度越高,糾正6月AIMS得分越低;腦室周圍白質(zhì)軟化與糾正1歲發(fā)育商呈負(fù)相關(guān)(P0.05),即腦室周圍白質(zhì)軟化程度越高,糾正1歲發(fā)育商越低;窒息程度與糾正1歲AIMS得分、糾正1歲發(fā)育商呈負(fù)相關(guān)(P0.05),即窒息程度越嚴(yán)重,糾正1歲AIMS得分、糾正1歲發(fā)育商越低;窒息程度與糾正6月社交行為呈負(fù)相關(guān)(P0.05),即窒息程度越嚴(yán)重,糾正6月社交行為得分越低。窒息程度與糾正1歲大動(dòng)作、糾正1歲社交行為呈負(fù)相關(guān)(P0.05),即窒息程度越嚴(yán)重,糾正1歲大動(dòng)作、糾正1歲社交行為得分越低。2.一般資料中的連續(xù)變量(孕周、出生體重、1分鐘Apgar評(píng)分、5分鐘Apgar評(píng)分、輔助通氣天數(shù)、需要氧療天數(shù)、住院天數(shù)、出生頭圍、出生身長(zhǎng))分別與結(jié)局變量(糾正6月AIMS得分、發(fā)育商;糾正1歲AIMS得分、發(fā)育商)進(jìn)行pearson相關(guān)分析發(fā)現(xiàn),輔助通氣天數(shù)與糾正1歲AIMS得分呈負(fù)相關(guān)(P0.05),即輔助通氣天數(shù)越多,糾正1歲AIMS得分越低;孕周與糾正6月大動(dòng)作呈正相關(guān)(P0.05),即孕周越大,糾正6月大動(dòng)作得分越高;孕周與糾正1歲適應(yīng)性呈正相關(guān)(P0.05),即孕周越大,糾正1歲適應(yīng)性得分越高。3.一般資料中的分類變量(出生體重、窒息程度、新生兒缺氧缺血性腦病、高膽紅素血癥、顱內(nèi)出血、宮內(nèi)感染、妊高癥、難產(chǎn)、先兆流產(chǎn))與結(jié)局變量(腦癱)進(jìn)行單因素卡方分析發(fā)現(xiàn),差異無(wú)統(tǒng)計(jì)學(xué)意義,P0.05。4.額葉代謝物(NAA、Cho、Cr、MI、Lac、NAA/Cr、Cho/Cr、MI/Cr、Lac/Cr)分別與結(jié)局變量(糾正6月AIMS得分、發(fā)育商;糾正1歲AIMS得分、發(fā)育商)進(jìn)行pearson相關(guān)分析發(fā)現(xiàn),差異均無(wú)統(tǒng)計(jì)學(xué)意義,P0.05。5.基底節(jié)代謝物(NAA、Cho、Cr、MI、Lac、NAA/Cr、Cho/Cr、MI/Cr、Lac/Cr)分別與結(jié)局變量(糾正6月AIMS得分、發(fā)育商;糾正1歲AIMS得分、發(fā)育商)進(jìn)行pearson相關(guān)分析發(fā)現(xiàn),基底節(jié)MI濃度與糾正1歲發(fā)育商呈負(fù)相關(guān)(P0.05),即基底節(jié)MI濃度越高,糾正1歲發(fā)育商越低;基底節(jié)MI濃度與糾正1歲大動(dòng)作、精細(xì)動(dòng)作、適應(yīng)性、社交行為呈負(fù)相關(guān)(P0.05),即基底節(jié)MI濃度越高,糾正1歲大動(dòng)作、精細(xì)動(dòng)作、適應(yīng)性、社交行為得分越低;基底節(jié)Cho/Cr比值與糾正1歲精細(xì)動(dòng)作呈負(fù)相關(guān)(P0.05),即基底節(jié)Cho/Cr比值越大,糾正1歲精細(xì)動(dòng)作得分越低;基底節(jié)MI/Cr比值與糾正1歲大動(dòng)作、精細(xì)動(dòng)作、適應(yīng)性、語(yǔ)言、社交行為呈負(fù)相關(guān)(P0.05),即基底節(jié)MI/Cr比值越大,糾正1歲大動(dòng)作、精細(xì)動(dòng)作、適應(yīng)性、語(yǔ)言、社交行為得分越低。6.海馬區(qū)代謝物(NAA、Cho、Cr、MI、Lac、NAA/Cr、Cho/Cr、MI/Cr、Lac/Cr)分別與結(jié)局變量(糾正6月AIMS得分、發(fā)育商;糾正1歲AIMS得分、發(fā)育商)進(jìn)行pearson相關(guān)分析發(fā)現(xiàn),海馬區(qū)Lac/Cr比值與糾正6月發(fā)育商呈負(fù)相關(guān)(P0.05),即海馬區(qū)Lac/Cr比值越高,糾正6月發(fā)育商越低;海馬區(qū)NAA/Cr比值與糾正6月大動(dòng)作呈正相關(guān)(P0.05),即海馬區(qū)NAA/Cr比值越高,糾正6月大動(dòng)作得分越高;海馬區(qū)MI濃度與糾正1歲適應(yīng)性呈負(fù)相關(guān)(P0.05),即海馬區(qū)MI濃度越高,糾正1歲適應(yīng)性得分越低。7.腦室周圍代謝物(NAA、Cho、Cr、MI、Lac、NAA/Cr、Cho/Cr、MI/Cr、Lac/Cr)分別與結(jié)局變量(糾正6月AIMS得分、發(fā)育商;糾正1歲AIMS得分、發(fā)育商)進(jìn)行pearson相關(guān)分析發(fā)現(xiàn),腦室周圍Lac濃度與糾正1歲發(fā)育商呈負(fù)相關(guān)(P0.05),即腦室周圍Lac濃度越高,糾正1歲發(fā)育商越低;腦室周圍Lac/Cr比值與糾正1歲AIMS得分、糾正1歲發(fā)育商呈負(fù)相關(guān)(P0.05),即腦室周圍Lac/Cr比值越高,糾正1歲AIMS得分、糾正1歲發(fā)育商越低;腦室周圍Lac濃度與糾正1歲大動(dòng)作、精細(xì)動(dòng)作呈負(fù)相關(guān)(P0.05),即腦室周圍Lac濃度越高,糾正1歲大動(dòng)作、精細(xì)動(dòng)作得分越低;腦室周圍MI/Cr比值與糾正1歲大動(dòng)作呈負(fù)相關(guān)(P0.05),即腦室周圍MI/Cr比值越大,糾正1歲大動(dòng)作得分越低;腦室周圍Lac/Cr比值與糾正1歲大動(dòng)作、精細(xì)動(dòng)作呈負(fù)相關(guān)(P0.05),即腦室周圍Lac/Cr比值越大,糾正1歲大動(dòng)作、精細(xì)動(dòng)作得分越低。8.小腦代謝物(NAA、Cho、Cr、MI、Lac、NAA/Cr、Cho/Cr、MI/Cr、Lac/Cr)分別與結(jié)局變量(糾正6月AIMS得分、發(fā)育商;糾正1歲AIMS得分、發(fā)育商)進(jìn)行pearson相關(guān)分析發(fā)現(xiàn),小腦Lac濃度與糾正1歲發(fā)育商呈負(fù)相關(guān)(P0.05),即小腦Lac濃度越高,糾正1歲發(fā)育商越低;小腦Lac/Cr比值與糾正1歲發(fā)育商呈負(fù)相關(guān)(P0.05),即小腦Lac/Cr比值越高,糾正1歲發(fā)育商越低;小腦Lac/Cr比值與糾正1歲大動(dòng)作呈負(fù)相關(guān)(P0.05),即小腦Lac/Cr比值越高,糾正1歲大動(dòng)作得分越低。9.多因素線性回歸分析:單因素(一般資料、各感興趣區(qū)腦內(nèi)代謝物)與結(jié)局變量(糾正6月AIMS得分、發(fā)育商;糾正1歲AIMS得分、發(fā)育商)進(jìn)行pearson相關(guān)分析后,將分析有統(tǒng)計(jì)學(xué)意義的變量作為自變量,結(jié)局變量(糾正6月AIMS得分、發(fā)育商;糾正1歲AIMS得分、發(fā)育商)作為因變量進(jìn)行多因素線性回歸分析發(fā)現(xiàn):早產(chǎn)兒糾正6月發(fā)育商、精細(xì)動(dòng)作的影響因素是海馬區(qū)Lac/Cr比值;早產(chǎn)兒糾正1歲AIMS得分的影響因素是窒息程度和輔助通氣天數(shù);早產(chǎn)兒糾正1歲發(fā)育商的影響因素是基底節(jié)MI/Cr比值、腦室周圍Lac濃度、腦室周圍白質(zhì)軟化、小腦Lac/cr比值;早產(chǎn)兒糾正1歲大動(dòng)作、精細(xì)動(dòng)作、適應(yīng)性、語(yǔ)言、社交行為的影響因素分別是基底節(jié)MI濃度、基底節(jié)MI/Cr比值、基底節(jié)MI/Cr比值、基底節(jié)MI/Cr比值、基底節(jié)MI/Cr比值。結(jié)論:1.早產(chǎn)兒足月時(shí)腦內(nèi)代謝物水平有助于預(yù)測(cè)神經(jīng)系統(tǒng)發(fā)育狀況。2.腦內(nèi)代謝物MI濃度、Lac濃度、NAA/Cr比值、Cho/Cr比值、MI/Cr比值、Lac/Cr比值有助于預(yù)測(cè)神經(jīng)系統(tǒng)發(fā)育狀況。3.腦內(nèi)代謝物MI/Cr比值預(yù)測(cè)神經(jīng)系統(tǒng)發(fā)育狀況的能力最好。4.在5個(gè)感興趣區(qū)(額葉、基底節(jié)、海馬、腦室周圍、小腦)中,基底節(jié)預(yù)測(cè)神經(jīng)系統(tǒng)發(fā)育狀況的能力最好。5.糾正6月和糾正1歲相比較,能夠預(yù)測(cè)的最佳時(shí)間點(diǎn)可能為糾正1歲。
[Abstract]:Objective: to detect the level of metabolites in the brain in preterm infants by magnetic resonance spectroscopy (MRI), and explore (1) whether the metabolites in the brain can predict the development of the nervous system; (2) how many kinds of intracerebral metabolites can predict the development of the nervous system; (3) which of the intracerebral metabolites to predict the development of the nervous system is the best; (4) which (4) The ability of a region of intra brain metabolites to predict the development of the nervous system is best; (5) the best time points that can be predicted. Methods: 1. pairs of preterm infants underwent MRI and MRS scan.2. for the correction of the term, and the AIMS assessment and GESELL assessment were performed at the correction of June and the correction of 1 years. Results: the classification changes in 1. general data Volume (sex, fetal number, premature rupture of fetal membrane, prenatal hormone use, delayed sepsis, intraventricular hemorrhage, periventricular hemorrhage, periventricular softening, mother's occupational condition, mother education, patent ductus arteriosus, postpartum steroid use, brainstem evoked potential, test tube infants, asphyxia, hypoxic-ischemic encephalopathy, hyperbilirubinemia, intrauterine Infection, pregnancy induced hypertension, dystocia, premonitory abortion) and outcome variables (correction of the June AIMS score, developmental quotient, correction of 1 year old AIMS score, developmental quotient) were found to have a negative correlation between the periventricular softening and the correction of the June AIMS score (P0.05), the higher the degree of white plasma softening around the ventricle, the lower the June AIMS score; around the ventricles of the brain. White plasma softening was negatively correlated with the correction of 1 year old developmental quotient (P0.05), that is, the higher the degree of cerebral softening around the ventricle, the lower the 1 year old development business, the degree of asphyxia was negatively correlated with the correction of the 1 year old AIMS score and the correction of the 1 year old development quotient (P0.05), that is, the more severe the asphyxia degree, the correction of the 1 year old AIMS score, and the correction of the lower 1 year development business, and the degree of asphyxia and correction of social interaction in June. Negative correlation (P0.05), that is, the more severe the degree of asphyxia, the lower the score of social behavior in June. The degree of asphyxia is negatively related to correcting 1 year old movements and correcting 1 years of social behavior (P0.05), that is, the more severe the degree of asphyxia, the correction of 1 year old movements, and the correction of the lower.2. general data of 1 years of social behavior (gestational, birth weight, 1). Minute Apgar score, 5 minute Apgar score, auxiliary ventilation days, oxygen therapy days, hospital days, birth head circumference, birth length) and outcome variables (correct June AIMS score, developmental quotient, correct 1 year old AIMS score, developmental quotient), Pearson correlation analysis found that the number of auxiliary ventilation days was negatively correlated with the correction of 1 year old AIMS score (P0.05), that is auxiliary (P0.05). The more the number of days of aid ventilation, the lower the score of correcting the 1 year old AIMS; the pregnancy week was positively correlated with the correction of the June big movement (P0.05), that is, the greater the gestational week, the higher the score of the major movement in June; the more the pregnancy week and the correction of the adaptability of the 1 year old (P0.05), that is, the greater the gestational age, the higher the 1 year old adaptive score higher in the general data (birth weight, asphyxia degree). The single factor chi square analysis of neonatal hypoxic-ischemic encephalopathy, hyperbilirubinemia, intracranial hemorrhage, intrauterine infection, pregnancy induced hypertension, dystocia, threatened abortion) and outcome variables (cerebral palsy) found no statistically significant difference. P0.05.4. frontal lobe metabolites (NAA, Cho, Cr, MI, Lac, NAA/Cr, Cho/Cr, MI/Cr, Lac/Cr) were respectively with the outcome variables (corrected for AIMS in June). Pearson correlation analysis of the 1 year old AIMS score and the developmental quotient found that the differences were not statistically significant. The P0.05.5. basal ganglia metabolites (NAA, Cho, Cr, MI, Lac, NAA/Cr, Cho/Cr, MI/Cr, Lac/Cr) were respectively analyzed with the outcome variables (correcting the June score, the developmental quotient, the correction of the 1 year old score, the developmental quotient). MI concentration was negatively correlated with the correction of 1 years old development quotient (P0.05), that is, the higher the concentration of basal ganglia MI, the lower the 1 year old development business, the basal ganglia MI concentration is negatively correlated with the correction of 1 year old movement, fine movement, adaptability and social behavior (P0.05), that is, the higher the concentration of basal ganglia MI, the correction of 1 year old movements, the lower the score of fine movement, adaptability, social behavior. The ratio of Cho/Cr in the basal ganglia was negatively correlated with the fine movement of 1 years old (P0.05). That is, the greater the ratio of basal ganglia Cho/Cr, the lower the score of correcting 1 year old fine movements; the basal ganglia MI/Cr ratio was negatively correlated with the correction of 1 year old movements, fine movements, adaptability, language and social behavior (P0.05), that is, the greater the ratio of basal ganglia MI/Cr, the correction of 1 year old movements, fine movements, The lower.6. hippocampal metabolites (NAA, Cho, Cr, MI, Lac, NAA/Cr, Cho/Cr, MI/Cr, Lac/Cr) in adaptive, language, and social behavior with the outcome variables (correction of the June AIMS score, the developmental quotient, the 1 year old AIMS score, the developmental quotient) and the correlation analysis, the hippocampal region was negatively correlated with the correction of the June developmental quotient, namely the hippocampus The higher the Lac/Cr ratio, the lower the development of the June, the NAA/Cr ratio in the hippocampus was positively correlated with the correction of the big movement in June (P0.05), that is, the higher the NAA/Cr ratio in the hippocampus, the higher the score of the June big action. The MI concentration in the hippocampus is negatively correlated with the adaptation to the adaptability of the 1 year old (P0.05), that is, the higher the concentration of the hippocampal MI, the lower the adaptability score of the hippocampus is the lower.7. ventricle. The peripheral metabolites (NAA, Cho, Cr, MI, Lac, NAA/Cr, Cho/Cr, MI/Cr, Lac/Cr) were respectively associated with the outcome variables (correction of the June AIMS score, the developmental quotient, the correction of the 1 year old AIMS score, the developmental quotient) and the Pearson correlation analysis found that the concentration around the ventricle was negatively correlated with the correction of the 1 year old development quotient, that is, the higher the concentration around the ventricle, the lower the 1 year old development. The Lac/Cr ratio around the ventricle was negatively correlated with correcting the 1 year old AIMS score and correcting the 1 year old developmental quotient (P0.05), that is, the higher the Lac/Cr ratio around the ventricle, the correction of the 1 year old AIMS score and the correction of the lower 1 year development business, and the negative correlation between the concentration of Lac around the ventricle and the correction of the 1 year old movement (P0.05), that is, the higher the concentration of Lac around the ventricle, the correction of 1 year old movements, semen, The lower the fine movement score, the MI/Cr ratio around the ventricle was negatively correlated with the correction of the 1 year old movement (P0.05), the greater the MI/Cr ratio around the ventricle, the lower the score for correcting the 1 year old movement; the Lac/Cr ratio around the ventricle was negatively correlated with the correction of the 1 year old movement and the fine movement (P0.05), the greater the Lac/Cr ratio around the ventricle, the correction of the 1 year old movement and fine movement. The lower.8.'s cerebellar metabolites (NAA, Cho, Cr, MI, Lac, NAA/Cr, Cho/Cr, MI/Cr, Lac/Cr) with the outcome variables (correction of the June AIMS score, the developmental quotient, the 1 year old AIMS score, the developmental quotient) found that the cerebellar concentration was negatively correlated with the correction of the 1 year old hair maker, that is, the higher the concentration of cerebellum, the lower the 1 year old development business is lower. The Lac/Cr ratio of cerebellum was negatively correlated with the 1 year old developmental quotient (P0.05), that is, the higher the Lac/Cr ratio of the cerebellum, the higher the Lac/Cr ratio of the cerebellum, the lower the 1 year old development business, and the negative correlation between the cerebellar Lac/Cr ratio and the correction of the 1 year old movement (P0.05), that is, the higher the Lac/Cr ratio of the cerebellum, the lower the.9. multifactor regression analysis is the lower the score of the correction of the 1 year old movement: the single factor (general data, each sensation) After the Pearson related analysis of the June AIMS score, the developmental quotient, the 1 year old AIMS score and the developmental quotient, the statistically significant variables were analyzed as the independent variable, the outcome variable (correction of the June AIMS score, the developmental quotient, the correction of the 1 year old AIMS score, the developmental quotient) as the dependent variable for multiple linear regression It was found that preterm infants corrected the June developmental quotient, the influencing factors of fine movements were the Lac/Cr ratio in the hippocampus, and the factors affecting the score of 1 year old AIMS in premature infants were the degree of asphyxia and the number of auxiliary ventilation days, and the factors affecting the 1 year old developmental quotient in preterm infants were the basal ganglia MI/Cr ratio, the concentration of Lac around the ventricle, the periventricular softening, the cerebellar Lac/ Cr ratio; the influence factors of premature infants to correct 1 year old movements, fine movements, adaptability, language and social behavior are basal ganglia MI concentration, basal ganglia MI/Cr ratio, basal ganglia MI/Cr ratio, basal ganglia MI/Cr ratio, basal ganglia MI/Cr ratio. Conclusion: the level of intracellular metabolites in 1. preterm infants is helpful to predict the nervous system development of.2. brain. MI concentration of metabolites, Lac concentration, NAA/Cr ratio, Cho/Cr ratio, MI/Cr ratio, Lac/Cr ratio help predict the ability of.3. brain metabolite MI/Cr ratio to predict the nervous system development in.3. best.4. in 5 regions of interest (frontal lobe, basal ganglia, sea horse, periventricle, cerebellum), and basal ganglia predict nervous system development The best way to correct.5. is to rectify June and correct the age of 1. The best time to predict is 1.

【學(xué)位授予單位】：廣州醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R722.6

【參考文獻(xiàn)】

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