Neurology:追踪13年(1月龄-13周岁),T1-W/T2-W 比值趋势与多维度智能发育相关,围产期危险因素增加偏离正常发育风险

2022-01-18 Naomi MedSci原创

极早产儿和多种已知的围产期危险因素与儿童和青春期白质区域T1-w/T2-w比值的长期降低有关。此外,13岁时T1-w/T2-w比值的增加与更好的运动和工作记忆功能有关,且VP和FT儿童存在发展差异。

      髓鞘是大脑中一个重要的结构,它包裹轴突以快速传递神经冲动。T1和T2加权磁共振图像(MRI)的图像强度比,即T1-w/T2-w,可以提供组织特征的信息,包括显微结构和髓鞘含量。T1-w/T2-w技术由于相对容易地可以从临床MRI检查中常规在短时间内获得的T1和T2加权图像计算出来,相对于其他髓鞘定位方法的一个主要优势是简单,使其更容易被用于临床研究,

      考虑到少突胶质细胞在幼年迅速成熟形成成熟的髓鞘,髓鞘成熟持续到青春期,从婴儿期到青春期是研究白质发育和调查偏离正常白质发育的关键时期。足月出生的婴儿(FT;≥妊娠37周)相比,早产儿(VP;妊娠<32周)被认为有发育髓鞘易损性。髓鞘发育与性别相关的差异很少有文献记载,还需要更多的证据以证明髓鞘不成熟是否是围产期因素如新生儿脑异常、宫内生长受限、出生后感染和支气管肺发育不良干扰VP脑发育的机制。

      从婴儿期到青春期不同的髓鞘形成轨迹对神经发育的影响仍有待确定。与10-13岁的FT儿童相比,VP儿童髓鞘发育的改变可能有助于解释他们神经发育障碍率更高的原因。

      近日,有研究人员探讨足月、7、13岁的FT和极早产(VP)儿童脑区白质发育的MRI图像(T1-w/T2-w)比值,包括:(1)出生组别或性别间的纵向变化是否存在差异;(2)VP儿童围产期危险因素的关系;(3)与13岁神经发育结局的关系,以期解决一下问题:

(1)a.比较VP组和FT组,7岁和13岁的男性和女性在48个主要白质区域的T1-w/T2-w值;

        b.确定从等值到13岁的T1-w/T2-w值在Vp组和FT组之间或性别之间是否存在差异。

(2)确定围产期变量,包括中、重度脑异常、胎龄偏小、感染和支气管肺发育不良,是否与VP患儿(A)横断面或(B)纵向T1-w/T2-w值有关。

(3)确定(A)横截面或(B)T1-w/T2-w值的纵向变化是否与所有13岁儿童的智力、运动、工作记忆、注意力、语言、执行功能、记忆和学习、学业和行为功能有关,以及出生组间的关系是否不同。

      对2001~2004年出生的VP(孕周<30周或<1250g)和FT患儿进行前瞻性纵向队列研究,并在足月等龄、7岁和13岁时进行随访,包括磁共振成像检查和神经发育评估。T1-w/T2-w图像被分成48个感兴趣的白质区域。

  • 在224名VP参与者和76名FT参与者中,197名VP和55名FT参与者拥有至少一个时间点的可用T1-w/T2-w数据。
  • T1-w/T2-w值在相当于足月到13岁之间增加,几乎没有证据表明纵向变化在出生群体或性别之间存在差异。
  • VP出生、新生儿脑异常、胎龄偏小和出生后感染与儿童和青春期局部T1-w/T2-w值降低有关。
  • 13岁时脑白质T1-w/T2-w值增加与所有儿童的运动和工作记忆功能改善有关。
  • 仅在FT组中,相当于7年的T1-w/T2-w值的较大增幅与较差的注意力和执行功能相关,而7岁时较高的T1-w/T2-w值与较差的数学相关。

      VP出生和多种已知的围产期危险因素与儿童和青春期白质区域T1-w/T2-w比值的长期降低有关,这可能与显微结构和髓鞘含量的改变有关。此外,13岁时T1-w/T2-w比值的增加似乎与更好的运动和工作记忆功能有关,而且VP和FT儿童在注意力、执行功能和数学方面的联系似乎存在发展差异。

文献来源:Thompson D, Yuan-Mou Yang J, Chen J, et al. Brain White Matter Development Over the First 13 Years in Very Preterm and Typically Developing Children Based on the T1-W/T2-W Ratio [published online ahead of print, 2021 Dec 22]. Neurology. 2021;10.1212/WNL.0000000000013250. doi:10.1212/WNL.0000000000013250

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    2022-12-12 yinhl1978
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    2022-01-18 ms1000001034537119

    学习啦#围产期#

    0

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    2022-01-18 ms8000000025759398

    学习了

    0

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    2022-01-18 JZzty

    学习了

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    2022-01-17 neurowu

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