振幅整合脑电图随访指标与极低出生体重儿神经预后相关性分析

doi:10.12372/jcp.2022.21e1476

摘要/Abstract

摘要：

目的分析振幅整合脑电图（aEEG）监测评分与极低出生体重儿神经预后的相关性。方法选取2016年1月至2019年1月分娩的224例极低出生体重儿,于新生儿出生1周内,矫正胎龄3月龄、6月龄和12月龄时进行aEEG监测,按矫正胎龄12月龄时的神经系统发育结局分为正常组与异常组,比较两组间aEEG监测评分差异。结果 224例极低出生体重儿中,男125例、女99例,胎龄（30.01±1.49）周,出生体重（1 366.64±119.43）g。矫正胎龄12月龄时,神经系统发育结局正常的153例,异常71例。出生1周内,正常和异常组之间睡眠周期（Cy）与总（T）评分差异具有统计学意义（P<0.05）;矫正胎龄3月龄、6月龄时,两组间图形连续性（Co）、Cy与T评分差异均有统计学意义（P<0.05）;矫正胎龄12月龄时,两组间Co、下界振幅（LB）、Cy、带宽（B）与T评分差异均有统计学意义（P<0.05）。二分类logistic回归分析显示,矫正胎龄12月龄的aEEG监测指标中Co、Cy、T评分与极低出生体重儿的神经系统发育结局显著相关（P<0.01）;评分越低,神经系统发育结局异常的风险越大。绘制ROC曲线,发现矫正胎龄12月龄的aEEG监测指标中Co、T评分对极低出生体重儿神经系统发育结局有中等的预测价值（AUC为0.71和0.82）。结论 aEEG随访指标与极低出生体重儿的神经预后存在相关性,具有一定的预测价值。

关键词: 振幅整合脑电图, 随访指标, 极低出生体重儿

Abstract:

Objective To analyze the correlation between amplitude-integrated electroencephalogram (aEEG) follow-up indicators and the neurological prognosis in very low birth weight infants. Methods A total of 224 very low birth weight infants delivered from January 2016 to January 2019 were selected for aEEG monitoring within one week after birth and at 3, 6 and 12 months of corrected gestational age. According to the neurological development outcome at 12 months of corrected gestational age, the infants were divided into normal group and abnormal group, and the difference of aEEG monitoring score between the two groups was compared. Results A total of 224 very low birth weight infants (125 boys and 99 girls) were included, the gestational age was (30.01±1.49) weeks and the birth weight was (1366.64±119.43) g. At 12 months of corrected gestational age, the nervous system development outcome was normal in 153 cases and abnormal in 71 cases. Within one week of birth, there was a statistically significant difference in sleep cycle (Cy) and total (T) scores between normal and abnormal groups (P<0.05). There were significant differences in graph continuity (Co), Cy and T scores between the two groups at 3 and 6 months of corrected gestational age (P<0.05). At 12 months of corrected gestational age, there were significant differences in Co, lower bound amplitude (LB), Cy, bandwidth (B) and T scores between the two groups (P<0.05). Binary logistic regression analysis showed that Co, Cy and T scores in aEEG monitoring indexes at 12 months of corrected gestational age were significantly correlated with the nervous system development outcome of very low birth weight infants (P<0.01), and the lower the score, the greater the risk of abnormal neurodevelopmental outcome. By drawing ROC curve, Co and T scores of aEEG at 12 months of gestational age were found to have moderate predictive value for the neurological outcome of very low birth weight infants (AUC 0.71 and 0.82). Conclusions The aEEG follow-up indicators are correlated with the neurological prognosis in very low birth weight infants and have certain predictive value.

Key words: amplitude integrated electroencephalogram, follow-up indicator, very low birth weight infant

曾晓靓, 闵青, 吴淑媛. 振幅整合脑电图随访指标与极低出生体重儿神经预后相关性分析[J]. 临床儿科杂志, 2022, 40(9): 679-684.

ZENG Xiaoliang, MIN Qing, WU Shuyuan. Correlation analysis of amplitude-integrated electroencephalogram follow-up indicators and neurological prognosis of very low birth weight infants[J]. Journal of Clinical Pediatrics, 2022, 40(9): 679-684.

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分值	Co	LB	Cy	B
0	不连续	<3 μV	无	低振幅（≤15 μV）和低电压（≤5 μV）
1	有些连续	3~5 μV	开始出现周期	高振幅（>20 μV）或中等振幅（16~20 μV）和低电压（≤5 μV）
2	连续	>5 μV	似乎有周期变化	高振幅（>20 μV）和高电压（>5 μV）
3			有周期变化,但存在打断情况	中等振幅（16~20 μV）和高电压（>5 μV）
4			有明确的周期且没有打断情况	低振幅（≤15 μV）和高电压（>5 μV）
5			规律且成熟

项目	异常组(n=71)	正常组(n=153)	统计量	P
胎龄(x±s)/周	30.24±1.37	29.91±1.54	t=1.54	0.124
体重(x±s)/g	1 371.65±116.28	1 364.32±120.89	t=0.43	0.670
男性[n(%)]	37(52.1)	88(57.5)	χ²=0.57	0.449
剖宫产[n(%)]	29(40.9)	49(32.0)	χ²=1.66	0.197
胎膜早破[n(%)]	21(29.6)	54(35.3)	χ²=0.71	0.399
妊娠期糖尿病[n(%)]	44(62.0)	102(66.7)	χ²=0.47	0.493
机械通气[n(%)]	48(67.6)	96(62.8)	χ²=0.50	0.480

组别	Co评分	LB评分	Cy评分	B评分	T评分
出生1周内
异常组(n=71)	0.95±0.26	1.01±0.24	1.27±0.35	1.39±0.42	4.62±1.07
正常组(n=153)	0.97±0.30	1.02±0.20	1.46±0.39	1.45±0.27	4.94±1.12
t值	0.484	0.326	2.949	1.286	2.018
P	0.629	0.745	0.004	0.200	0.045
矫正胎龄3月龄
异常组(n=71)	0.97±0.26	1.02±0.26	1.31±0.47	1.43±0.46	4.75±1.18
正常组(n=153)	1.06±0.34	1.04±0.23	1.58±0.56	1.52±0.38	5.20±1.24
t值	1.98	0.58	3.53	1.54	2.57
P	0.049	0.562	0.001	0.125	0.011
矫正胎龄6月龄
异常组(n=71)	1.05±0.38	1.13±0.34	1.87±0.62	1.72±0.31	5.77±1.94
正常组(n=153)	1.19±0.44	1.21±0.30	2.39±0.85	1.79±0.44	6.71±2.13
t值	2.31	1.78	4.61	1.21	3.16
P	0.022	0.077	<0.001	0.228	0.002
矫正胎龄12月龄
异常组(n=71)	1.22±0.42	1.24±0.32	2.04±0.64	2.13±0.56	6.68±2.46
正常组(n=153)	1.42±0.54	1.42±0.49	3.12±1.18	2.59±0.88	8.35±2.91
t值	2.76	2.83	7.23	4.04	4.19
P	0.006	0.005	<0.001	<0.001	<0.001

aEEG监测得分	回归系数	标准误	χ²值	P	OR(95%CI)
Co评分	–0.14	0.51	0.08	<0.001	0.87(0.71~0.94)
LB评分	–0.58	0.73	0.63	0.343	0.56(0.31~1.48)
Cy评分	–0.20	0.48	0.17	<0.001	0.82(0.68~0.89)
B评分	–0.45	0.68	0.43	0.267	0.64(0.28~1.24)
T评分	–0.07	0.39	0.04	<0.001	0.93(0.81~0.97)
常量	–6.91	1.25	30.69	<0.001	0.001

评分	截断值/分	AUC	95%CI	灵敏度/%	特异度/%	阳性预测值/%	阴性预测值/%
Co	1	0.71	0.56~0.84	79.26	72.18	74.83	69.72
Cy	3	0.68	0.55~0.83	76.47	70.51	71.96	67.48
T	7	0.82	0.74~0.93	84.26	79.74	86.26	85.18