衰弱综合征的中医量表编制及信效度检验

Development and Validity and Reliability Testing of a Traditional Chinese Medicine Scale for Debility Syndrome

:-
 
目的 编制适用于老年人群的衰弱综合征中医评估量表并检验其信度与效度。方法 通过文献研究及《中华医典》检索构建条目池,采用4轮德尔菲专家咨询及预调查筛选条目形成初量表;便利抽取300例老年患者行横断面调查,以Fried表型衰弱量表为校标,进行项目分析、Cronbach’s α系数、探索性因子分析及ROC曲线分析。 结果 经条目筛选最终形成含5个核心症状条目(表A)及38个证候条目(表B)的量表。表A校标关联效度r=0.929(P<0.05),AUC=0.957,灵敏度0.949,特异度0.859;表A+B校标关联效度r=0.648(P<0.05),AUC=0.827,灵敏度0.606,特异度0.911;总量表Cronbach's α=0.872。结论 所研制的衰弱综合征中医量表信效度良好,可用于老年人衰弱状态筛查及中医证型判别。
Objective: To develop a Traditional Chinese Medicine (TCM) assessment scale for frailty syndrome in the elderly and to evaluate its reliability and validity. Methods: An item pool was constructed through literature review and searches of the *Chinese Medical Canon*. A preliminary scale was developed through four rounds of Delphi expert consultation and a pilot survey. A cross-sectional survey was conducted using a convenience sample of 300 elderly patients. Using the Fried Phenotypic Frailty Scale as the gold standard, item analysis, Cronbach’s α coefficient, exploratory factor analysis, and ROC curve analysis were performed. Results: After item screening, the final scale comprised 5 core symptom items (Table A) and 38 syndrome items (Table B). For Table A, the criterion-related validity was r = 0.929 (P < 0.05), AUC = 0.957, sensitivity = 0.949, and specificity = 0.859; Table A+B showed a test-retest reliability of r = 0.648 (P < 0.05), an AUC of 0.827, a sensitivity of 0.606, and a specificity of 0.911; the total scale had a Cronbach’s α of 0.872. Conclusion: The developed Traditional Chinese Medicine (TCM) frailty syndrome scale demonstrates good reliability and validity and can be used for screening frailty in the elderly and for distinguishing TCM syndrome patterns.
论著

精子 DNA 碎片指数对体外受精 - 胚胎移植妊娠结局及胚胎发育的影响

Impact of sperm DNA fragmentation index on pregnancy outcomes and embryo development in vitro fertilization-embryo transfer

:389-395
 
      目的  探讨精子DNA碎片指数(DFI)对体外受精-胚胎移植(IVF-ET)胚胎发育及妊娠结局的影响,为优化男性生育力评估及辅助生殖治疗策略提供依据。方法  回顾性分析2023年1月—2024年1月于徐州市妇幼保健院接受IVF-ET治疗的126对不孕夫妇,根据男方DFI检测结果分为低碎片组(DFI≤15%,n=42)、临界组(15%<DFI<30%,n=45)和高碎片组(DFI≥30%,n=39)。比较三组患者受精相关指标、胚胎发育指标及妊娠结局指标的差异,并分析DFI与各指标的相关性。结果  低碎片组双原核率(2PN)率、优质胚胎率及囊胚形成率均高于临界组和高碎片组(P<0.001),低碎片组1PN率、多PN率均低于临界组和高碎片组(P<0.001);三组种植率、临床妊娠率、早期流产率比较差异无统计学意义(P>0.05),但高碎片组活产率低于低碎片组(P<0.05)。相关性分析结果表明,DFI与优质胚胎率(r=-0.412,P<0.001)、囊胚形成率(r=-0.387,P<0.001)、活产率(r=-0.287,P=0.012)呈负相关,与早期流产率(r=0.206,P=0.059)、种植率(r=-0.215,P=0.058)、临床妊娠率(r=-0.203,P=0.072)无显著相关性。结论  精子DNA碎片指数是影响IVF-ET胚胎发育及妊娠结局的重要因素,高DFI主要通过降低胚胎发育潜能及增加流产风险导致活产率下降,临床需对高DFI患者进行干预以改善治疗结局。
       Objective  To investigate the impact of sperm DNA fragmentation index(DFI)on embryo development and pregnancy outcomes of in vitro fertilization-embryo transfer(IVF-ET),and to provide a basis for optimizing male fertility assessment and assisted reproductive treatment strategies.Methods  A retrospective analysis was performed on 126 infertile couples undergoing IVF-ET treatment at the Reproductive Medicine Center of Xuzhou Maternal and Child Health Hospital from January 2023 to January 2024.According to the male DFI test results,they were divided into three groups:low fragmentation group(DFI≤15%,n=42),critical group(15% < DFI < 30%,n=45),and high fragmentation group(DFI≥30%,n=39).Differences in fertilization-related indicators,embryo development indicators,and pregnancy outcome indicators were compared among the three groups,and the correlation between DFI and each indicator was analyzed.Results  The 2 pronuclei rate(PN)rate,high-quality embryo rate,and blastocyst formation rate in the low fragmentation group were significantly higher than those in the critical and high fragmentation groups(P<0.001).The 1PN  rate and multi-PN  rate in the low fragmentation group were significantly lower than those in the critical and high fragmentation groups(P<0.001).There was no significant difference in the three groups of implantation rate,clinical pregnancy rate and early abortion rate(P>0.05),but the live birth rate of high fragment group was significantly lower than that of low fragment group(P<0.05).The results of correlation analysis showed that DFI was significantly negatively correlated with the rate of high quality embryos(r=-0.412,P<0.001),blastocyst formation rate(r=-0.387,P<0.001)and live birth rate(r=-0.287,P=0.012),but not with the rate of early abortion(r=0.206,P=0.059),implantation rate(r=-0.215,P=0.058)and clinical pregnancy rate(r=-0.203,P=0.072).Conclusions  Sperm DFI is an important factor affecting embryo development and pregnancy maintenance in IVF-ET.High DFI leads to a decrease in live birth rate mainly by reducing embryo developmental potential and increasing the risk of early abortion.Clinically,early intervention is needed for patients with high DFI to improve treatment outcomes.
论著

基于机器学习的结肠息肉术后复发风险预警模型构建

Machine learning-based development of a recurrence risk prediction model for post-polypectomy colonic polyps

:315-326
 
       目的  探讨结肠镜下息肉切除术后复发的危险因素,并基于机器学习算法构建复发风险预警模型,为防治对策提供依据。方法  回顾性收集2018年9月—2023年9月六安市人民医院1 058例初次行无痛结肠镜下息肉切除术患者的临床资料,使用单因素和多因素Logistic回归分析筛选复发危险因素。采用7∶3随机抽样分为训练集和验证集,分别通过决策树、贝叶斯及Logistic回归算法构建预测模型,并以受试者工作特征曲线(ROC)曲线下面积(AUC)、灵敏度、特异度等指标来评估模型效能。结果  单因素分析显示,性别、吸烟、代谢综合征、息肉数量、息肉位置、山田分型、组织病理学类型、切除方式、复查时间、肠息肉直径、手术时间是复发的危险因素(P<0.05)。多因素分析显示,性别、代谢综合征、息肉数量、息肉直径、肠息肉位置、山田分型、组织学病理类型、切除方式、手术时间均是结肠息肉内镜下切除术后复发的危险因素。模型评估显示,决策树算法、贝叶斯算法、Logistic回归算法的ROC曲线下面积(AUC)分别为0.849、0.818、0.811;灵敏度分别为85.14%、81.62%、79.43%;特异度分别为81.69%、79.45%、74.18%;约登指数分别为0.534、0.551、0.573;95%CI分别为0.810~0.876、0.794~0.860、0.782~0.850;决策树算法模型效能最佳,Logistic回归算法的性能最差。结论  性别、代谢综合征、肠息肉特征(数量、直径、位置等)是术后复发的关键危险因素。决策树模型在风险预测中表现最优,可为临床制定个体化随访策略提供参考。
       Objective  To explore the  risk factors for  recurrence after painless colonoscopic polypectomy and construct a recurrence risk warning model based on machine learning algorithms to provide evidence for prevention and treatment strategies.Methods  A retrospective analysis was conducted on clinical data from 1 058 patients who underwent their first painless colonoscopy-guided polypectomy at our hospital between September 2018 and September 2023.Univariate and multivariate Logistic  regression analyses were performed to identify recurrence risk factors.The dataset was randomly divided into training and validation sets using a 7∶3 ratio.Prediction models were constructed using decision tree,Bayesian,and Logistic regression algorithms,and their performance was evaluated using metrics such as the area under the receiver operating characteristic curve(AUC),sensitivity,specificity,and others.Results  Univariate analysis revealed that gender,smoking,metabolic syndrome,number of polyps,polyp location,Yamada classification,histopathological type,resection method,follow-up time,polyp diameter,and operation duration were risk factors for recurrence(P<0.05).Multivariate analysis identified gender,metabolic syndrome,number of polyps,polyp diameter,polyp location,Yamada classification,histopathological type,resection method,and operation duration as independent risk factors for recurrence after endoscopic polypectomy.Model evaluation showed AUC values of 0.849,0.818,and 0.811 for the decision tree,Bayesian,and Logistic regression algorithms,respectively.Sensitivity values were 85.14%,81.62%,and 79.43%;specificity values were 81.69%,79.45%,and 74.18%;Youden’s indices were 0.534,0.551,and 0.573;and 95% confidence intervals(CIs)were 0.810–0.876,0.794–0.860,and 0.782–0.850,respectively.The  decision tree algorithm demonstrated the best predictive performance,while the Logistic regression algorithm performed the least favorably.Conclusions  Gender,metabolic syndrome,and polyp characteristics(number,diameter,location,etc.)are key  risk factors for recurrence after polypectomy.The decision tree algorithm exhibited optimal predictive efficacy,offering valuable insights for developing individualized follow-up strategies in clinical practice.
学术前沿

纤毛发育中基因的转录调控机制综述

A review on the transcriptional regulatory mechanisms of ciliary development

:270-276
 
       纤毛是细胞表面的重要细胞器,广泛参与细胞运动、感知外界信号和维持器官功能等生理过程。纤毛的形成,即纤毛发生(ciliogenesis)是一个高度复杂且受精密调控的过程,涉及大量与纤毛结构和功能相关基因的表达与调控。近年来,随着基因组学和发育生物学的发展,越来越多的研究揭示了多种关键转录因子在纤毛发生中的调控作用,包括RFX家族、FOXJ1、MCIDAS、GEMC1、MYB、E2F等。这些转录因子共同构成了一个多层次、多通路交织的调控网络,调控纤毛组装、基体复制、纤毛定位和功能维持等多个方面。本文系统综述了纤毛相关基因转录调控的研究进展,特别是关键转录因子的功能、相互作用及其在纤毛病中的作用,为深入理解纤毛的发育机制和疾病治疗提供参考。
       Cilia are crucial cell-surface organelles involved in cell movement,signal sensing,and organ function maintenance.Their formation,or ciliogenesis,is a complex and  precisely controlled  process that  requires the expression and regulation of numerous cilia-related genes.Recent advances in genomics and developmental biology have uncovered the  regulatory roles of key transcription factors like the RFX family,FOXJ1,MCIDAS,GEMC1,MYB,and E2F in ciliogenesis.These factors form a multi-level,interconnected regulatory network that oversees cilium assembly,basal body replication,ciliary positioning,and function preservation.This review systematically examines current research on transcriptional regulation of ciliary genes,with a focus on the roles,interactions,and contributions of these key transcription factors to ciliopathies,offering insights into ciliary development and disease treatment.
医院管理

广东省卒中中心建设进展及改进措施初探

Development and improvement measures of Stroke Center in Guangdong Province

:240-247
 
       目的 分析广东省卒中中心建设现状及存在的问题,提出切实可行的改善建议。方法 基于广泛的文献调研, 通过问卷对广东省护士协会卒中中心建设与管理分会相关单位开展问卷调查, 统计分析其在医院管理制度、医护人员卒中救治水平及健康宣教等方面的现状与问题。结果 广东省卒中中心建设与管理委员会相关单位在卒中救治中基本实现跨学科合作, 院前评估制度基本满足卒中判断需求, 在提高卒中救治效率方面已基本形成共识, 卒中健康宣教基本满足患者需求, 但方式有待改进, 卒中随访制度和个案管理制度基本符合要求; 存在的问题包括卒中中心一线救治人员外出交流学习机会较少; 院前评估数据采集的便利性有待提高; 卒中康复需求仍难以满足; 健康宣教工作仍需加强。结论 广东省卒中中心建设与管理委员会相关单位在卒中院前评估、院内救治、出院随访和健康宣教方面能够满足患者需求, 但仍存在不足。建议相关单位为一线工作人员提供更多外出交流学习机会, 充分应用互联网和物联网技术提高院前卒中数据采集共享便利性; 加强多种形式的科普宣教, 继续完善拓展卒中康复治疗和护理服务并完善相关制度。
       Objective To understand the current situation of construction and existing problems of Stroke Center in Guangdong Province.Put forward feasible suggestions for improvement.Methods Based on extensive literature research, a questionnaire was designed to investigate the relevant organizations of Stroke Center Construction and Management Branch of Guangdong Nurses Association.The status quo and existing problems in hospital management system, stroke treatment level of medical staff, health education and other aspects were statistically analyzed.Results The relevant organizations of the Guangdong Stroke Center Construction and Management Committee could basically achieve interdisciplinary cooperation in stroke treatment, the pre-hospital assessment system basically met the needs of stroke judgment, and a consensus was basically reached on how to improve the efficiency of stroke treatment.Stroke health education basically met the needs of patients but the methods need to be improved.The stroke follow-up system and case management system basically met the requirements,but there were not many opportunities for first-line treatment personnel in stroke centers to exchange and study abroad.The convenience of data collection for pre-hospital assessment needed to be improved.Stroke rehabilitation needs were still difficult to meet.Health education still needs to be strengthened.Conclusions The relevant units of Guangdong Stroke Center Construction and Management Committee can meet the needs of patients in the aspects of pre-hospital assessment, in-hospital treatment,discharge follow-up and health education, but there are still shortcomings.It is suggested that relevant organizations provide more opportunities for front-line staff to exchange and study abroad, make full use of Internet and Internet of Things technology to improve the convenience of pre-hospital stroke data collection and sharing.Strengthen various forms of science popularization and education, and continue to improve and expand stroke rehabilitation treatment and nursing services, improve relevant systems.
论著

基于图卷积神经网络的孤独症谱系障碍多模态数据融合与诊断模型研究

Development of an interpretable graph convolutional neural network for multimodal evidence integration and quantitative diagnosis of autism spectrum disorder

:39-45
 
       目的   针对孤独症多模态证据融合与定量化辨识的关键问题,本研究提出基于图卷积神经网络(GCN)的孤独症谱系障碍(ASD)诊断模型研究思路。方法  通过对来源于ABIDE的ASD儿童脑部fMRI数据进行整理和筛选,提取脑区功能连接矩阵作为图结构的邻接矩阵,并融合临床表型数据,构建了ASD多模态关联网络。通过网络特征比较分析,识别出了ASD与典型发育组的脑功能连接网络组间差异。进一步地构建一个端到端的GCN模型,并尝试引入注意力机制,提高模型决策的可解释性。结果  该模型在诊断性能指标优于传统机器学习方法(准确率=0.710,精确率=0.709,召回率=0.780,F1=0.743,曲线下面积=0.746)。背侧注意网络与边缘系统-颞极枢纽的功能连接减弱是模型做出判断的最主要依据。结论  以异质图为多模态数据整合的基本架构,本模型为ASD的潜在病理机制探索提供了新的方法学范例。
      Objective   To develop a quantitative model for autism spectrum disorder(ASD)integration multimodal evidences.Methods The fMRI  dataset from ABIDE was  used for extracting connectivity function  network of ASD after  data preprocessing.Difference between ASD and typical development about their brain connectivity function was evaluated with t-test.Integrating phenotypic data and fMRI dataset,an graph convolutional neural network (GCN)with attention module was estimated and compared against benchmark models about their efficiency and interpretability.Results  The GCN model was evaluated outperformed other models with better accuracy indices.And regions from Dorsal Attention Network and Limbic-Temporal Pole were ranked as the highest weights for the differentiation in the model.Conclusions  This study provided a novel paradigm for quantitative diagnosis and exploring pathogenesis of ASD.
论著

急性缺血性脑卒中介入治疗优化护理路径的构建及应用

Development and application of an optimized nursing pathway for endovascular therapy in acute ischemic stroke

:1563-1568
 
       目的   探讨优化护理路径在急性缺血性脑卒中介入手术中的应用及效果。方法   采用随机对照研究,纳入2024年1月—2025年1月收治的112例急性缺血性脑卒中取栓患者,观察组(56例)实施优化介入护理路径,对照组(56例)采用常规护理。结果   观察组患者的满意度评分、医护满意度评分均优于对照组(P<0.05);观察组的术前等待时间、患者自进入介入室至股动脉穿刺时间、手术时间、住院费用、并发症发生率、差错事故发生率也优于对照组(P<0.05)。结论   通过标准化术前准备、术中多学科协作及术后康复衔接,优化护理路径可显著提升急性缺血性脑卒中治疗时效性(缩短急性脑卒中患者从进入医院到开始静脉溶栓给药的时间至黄金时间窗内),改善患者神经功能预后。
       Objective  To explore the application and efficacy of an optimized nursing pathway in endovascular therapy for acute ischemic stroke(AIS).Methods  A randomized controlled trial was conducted,enrolling 112 AIS patients undergoing mechanical thrombectomy from January 2024 to January 2025.Patients were randomly assigned to either the observation groupn=56),which received the optimized interventional nursing pathway,or the control group(n=56),which  received  routine nursing care.Results  Patient satisfaction score,medical staff satisfaction score,and postoperative favorable  recovery  rate in observation group were better than those of control group(P<0.05).Additionally,the observation group  showed  significant improvements in preoperative waiting time,time from entering the operation room to femoral artery puncture,surgical duration,hospitalization costs,complication incidence rate,and medical error incidence rate(P<0.05).Conclusions  By standardizing preoperative preparations,implementing intraoperative multidisciplinary collaboration,and enhancing postoperative  rehabilitation coordination,the optimized nursing pathway significantly improved the timeliness of thrombectomy treatment(shortening door-to-needle time to reach the golden time window)and enhanced neurological functional prognosis in AIS patients,demonstrating substantial clinical applicability.
综述

脓毒症患者发生心肌损伤的高危因素分析

High-risk factors for the development of myocardial injury in patients with sepsis

:1338-1345
 
脓毒症当前仍然是全球范围内重要的医疗卫生问题,其对世界公共卫生及患者安全带来重大威胁。脓毒症是指宿主对感染反应失调引起的危及生命的器官功能障碍, 其发病率和病死率均极高,是临床重症医学中的重大挑战。在脓毒症病情的进展过程中, 可出现组织灌注不足、血流动力学不稳定等变化, 从而导致多器官功能受损,而心脏是常见的被累及的重要靶器官之一, 这种由脓毒症所导致的不同程度的心肌损伤, 被称为“脓毒性心肌病”, 其发生和发展机制复杂多样, 涉及循环心肌抑制因素、心肌自身因素及自主神经失调等多个方面。文章综述了脓毒症患者发生心肌损伤的高危因素, 以期为临床治疗和预防提供参考。
Sepsis currently remains an important global healthcare issue, and a major threat to world public health and patient safety.Sepsis is a life-threatening organ dysfunction caused by dysregulation of the host response to infection, with extremely high morbidity and mortality,which is a major challenge in clinical critical care medicine.During the progression of sepsis, changes such as inadequate tissue perfusion and haemodynamic instability may occur, leading to impairment of multiple organ functions, while the heart is one of the commonly involved vital target organs, and the varying degree of myocardial damage caused by sepsis is known as “septic cardiomyopathy”.The mechanisms of its occurrence and development are complex and diverse, involving circulating myocardial inhibitory factors, myocardial auto-factors, and autonomic dysregulation.In this paper, we review the high-risk factors for myocardial injury in septic patients, providing a reference for clinical treatment and prevention.
专家述评

智能可变形纳米载体的设计策略及其抗肿瘤应用研究进展

Recent development of smart deformable nanocarriers for antitumor application

:1311-1329
 
近年来, 药物递送系统在肿瘤靶向治疗领域取得了显著进展, 已有多种递药系统获批临床应用。其中, 纳米药物因其能够减少传统小分子化疗药物的毒副作用、提高药物生物利用度,并通过增强通透性与滞留效应(EPR效应)实现肿瘤的被动靶向, 从而显著提升治疗效果, 受到广泛关注。尤其是具备尺寸可调、肿瘤特异性聚集、刺激响应性崩解及形貌转变等多功能的智能可变形纳米载体, 已成为当前纳米递药载体研究的热点。这类载体能够感应肿瘤微环境中的特定刺激信号(如酸性pH值、过氧化还原状态、酶活性或过表达细胞因子), 实现包括尺寸调控、聚集组装、结构崩解与形态重构等在内的多种动态变形行为, 从而提升药物在肿瘤部位的滞留时间、渗透深度及控释能力, 最终获得更优的抗肿瘤疗效。例如在肿瘤组织中实现纳米载体尺寸缩小可增强药物的组织穿透力; 纳米粒子聚集变大会延长药物在病灶处的滞留时间; 而快速响应性崩解则有助于药物在肿瘤局部实现高效释放。这些智能变形策略为纳米药物递送系统提供了更高的治疗可控性与精准性。基于其多样化的响应特性和结构可塑性, 智能变形纳米载体在推动抗肿瘤药物的个体化治疗及联合疗法应用方面展现出巨大潜力。本文综述了近年来基于智能变形纳米载体增强抗肿瘤效果的研究进展,系统梳理了其设计策略, 并深入探讨了其在肿瘤精准治疗中的应用前景。
In recent years, drug delivery systems have made remarkable progress in the field of tumor-targeted therapy, with several platforms already approved for clinical use.Among them, nanomedicines have attracted considerable attention due to their ability to mitigate the side effects of conventional small-molecule chemotherapeutics, improve bioavailability, and passively accumulate at tumor sites via the enhanced permeability and retention(EPR)effect, thereby enhancing therapeutic efficacy.Of particular interest are stimuli-responsive, shape-transformable nanocarriers, which exhibit unique properties such as tunable size, tumor-specific accumulation, and structural adaptability in response to tumor-associated cues.These intelligent deformable nanocarriers are capable of undergoing various dynamic transformations—including aggregation, disassembly, size modulation, and morphological transitions—triggered by specific stimuli in the tumor microenvironment(TME), such as pH, redox potential,enzymes,or cytokines.Such transformations enhance drug retention at tumor sites, improve intratumoral penetration, and enable spatiotemporally controlled drug release, ultimately resulting in superior antitumor efficacy.For instance, nanosystems that shrink in size at tumor sites can promote deeper tissue penetration, while those that aggregate into larger assemblies can prolong local drug retention.Conversely, carriers that disassemble rapidly under tumor-specific stimuli allow for burst release of the encapsulated payload precisely at the disease site.These adaptive features hold great promise for improving the therapeutic performance of nanomedicines. Furthermore, the multifunctionality of intelligent deformable nanocarriers supports the development of personalized treatment regimens and combination therapies, offering novel strategies for cancer management.This review highlights recent advances in the design and application of shape-transformable nanocarriers for enhanced anticancer drug delivery, summarizing design principles and exploring their emerging potential in precision oncology.
论著

振幅整合脑电图联合头颅磁共振预测早产儿矫正12月龄时神经发育的价值

Predictive value of aEEG combined with cranial MRI on neurodevelopment for preterm infants at corrected age of 12 months

:513-518
 
目的 探讨振幅整合脑电图(aEEG)联合头颅磁共振成像(cMRI)对早产儿矫正12月龄时神经发育的预测价值。方法 选取110例早产儿为研究对象,并在矫正12月龄时采用Gesell 发育量表评估发育商(DQ),依据DQ分为Gesell 正常组(DQ≥85,n=83)、Gesell 异常组(DQ<85,n=27)。采集早产儿及母亲临床资料,对比两组出生后72 h内aEEG、矫正胎龄37周时cMRI检查指标差异。结果 两组早产儿及母亲基线资料比较差异无统计学意义(P>0.05)。相较于Gesell 正常组,Gesell 异常组双顶径(BPW)降低[(70.68±5.32)mm vs(66.54±3.69)mm],睡眠-觉醒周期(SWC)不成熟率(20.48% vs 85.19%)、aEEG异常率(30.12% vs 70.37%)、两半球间距(IHD)增高[(2.95±0.83) mm vs(3.56±0.72)mm](P<0.05)。Pearson相关分析结果显示,DQ值与IHD呈负相关,DQ值与BPW呈正相关(r=-0.361、0.598,P<0.05)。二元Logistic回归分析结果显示,BPW增高是Gesell 异常的独立保护因素(P<0.05),IHD增高、SWC不成熟及aEEG异常是Gesell 异常的独立危险因素(P<0.05)。结论 早产儿出生后72 h内aEEG异常、矫正胎龄37周时cMRI异常可能提示矫正12月龄时不良神经发育结局。
Objective To evaluate the predictive value of amplitude-integrated electroencephalogram combined with cranial magnetic resonance on neurodevelopment for preterm infants at corrected age of 12 months.Methods A total of 110 preterm infants were selected as study subjects,and Gesell developmental scale was used to evaluate developmental quotient(DQ)at corrected age of 12 months.According to DQ,they were divided into normal Gesell group(DQ≥85,n=83)and abnormal Gesell group(DQ<85,n=27).Clinical data of preterm infants and their mothers were collected,and the differences of amplitude-integrated electroencephalogram and cranial MRI(cMRI)were compared between two groups.Results There was no significant difference in baseline data between two groups(P>0.05).Compared with the normal Gesell group,the biparirtal width(BPW)in the abnormal Gesell group was decreased(70.68±5.32mm vs 66.54±3.69mm),the immaturity rate of sleep-wake cycle(SWC)(20.48% vs 85.19%),the abnormal rate of aEEG(30.12% vs 70.37%),and(IHD)(2.95±0.83mm vs 3.56±0.72mm)were increased(P<0.05).The results of Pearson correlation analysis showed that DQ was negatively correlated with IHD,and DQ was positively correlated with BPW(r=-0.361、0.598,P<0.05).Binary Logistic regression analysis showed that increased BPW was an independent protective factor for abnormal Gesell(P<0.05),and increased IHD,immature SWC and abnormal aEEG were independent risk factors for abnormal Gesell(P<0.05).Conclusions Abnormal aEEG within 72h after birth and abnormal cMRI at corrected age of 37 weeks may lead to adverse neurodevelopmental outcomes at corrected age of 12 months.
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