目的 探讨磁共振成像(MRI)表观扩散系数(ADC)联合血清胰岛素样生长因子1(IGF-1)水平对早产儿脑白质损伤(PWML)诊断和预后评估的临床价值.方法 选择PWML早产儿114例(观察组),其中PWML病情程度轻度35例、中度46例、重度33例,规范治疗后预后良好85例、预后不良29例,同期另选无颅脑疾病的早产儿34例(对照组).所有早产儿出生2周内接受颅脑MRI检查,常规行扩散张量成像扫描,选取感兴趣区测量ADC;采集外周静脉血,离心留取血清,采用ELISA法检测血清IGF-1.采用受试者工作特征(ROC)曲线分析ADC和血清IGF-1水平对PWML早产儿诊断和预后评估的临床价值.结果 观察组ADC和血清IGF-1水平均低于对照组(P均<0.05);随着病情程度增加,PWML早产儿ADC和血清IGF-1水平逐渐降低(P均<0.05).预后不良者ADC和血清IGF-1水平均低于预后良好者(P均<0.05).ADC、血清IGF-1水平单独和联合诊断早产儿PWML的曲线下面积(AUC)分别为0.772、0.762、0.960,ADC、血清IGF-1水平联合诊断早产儿PWML的AUC高于二者单独(Z分别为3.951、5.033,P均<0.05).PWML早产儿预后不良者ADC和血清IGF-1水平均低于预后良好者(P均<0.05).ADC、血清IGF-1水平单独和联合预测PWML早产儿预后的AUC分别为0.722、0.636、0.950,ADC、血清IGF-1水平联合预测PWML早产儿预后的AUC高于二者单独(Z分别为3.887、5.292,P均<0.05).结论 PWML早产儿ADC和血清IGF-1水平均降低,二者变化与PWML早产儿病情程度加重和预后不良有关;ADC和血清IGF-1水平对PWML早产儿诊断和预后评估均有一定临床价值,二者联合临床价值更高.
Objective To investigate the clinical value of magnetic resonance imaging(MRI)apparent diffusion coefficient(ADC)combined with serum insulin-like growth factor 1(IGF-1)level in the diagnosis and prognosis of punc-tate white matter lesions(PWML)in preterm infants.Methods Totally 114 preterm infants with PWML were selected(observation group),including 35 cases with mild PWML,46 cases with moderate PWML,33 cases with severe PWML,during which,85 cases had good prognosis after standard treatment and 29 cases had poor prognosis;and 34 preterm infants without cranial diseases(control group)were selected during the same period.Brain MRI was performed on all pre-term infants within 2 weeks of birth.Diffusion tensor imaging(DTI)scan was performed routinely,and ADC was mea-sured in areas of interest.Peripheral venous blood was collected,serum was collected by centrifugation,and serum IGF-1 was detected by ELISA.Receiver operating characteristic(ROC)curve was used to analyze the clinical value of ADC and serum IGF-1 levels in the diagnosis and prognosis of PWML preterm infants.Results The levels of ADC and IGF-1 in the observation group were lower than those in the control group(both P<0.05).The levels of ADC and serum IGF-1 in PWML preterm infants decreased gradually with the increase of disease severity(both P<0.05).The levels of ADC and IGF-1 in patients with poor prognosis were lower than those in patients with good prognosis(both P<0.05).The area under the curve(AUC)of ADC and serum IGF-1 levels for PWML in preterm infants were 0.772,0.762 and 0.960,respectively,and the AUC of ADC and serum IGF-1 levels for PWML in preterm infants was higher than that of ADC and serum IGF-1 levels alone(Z=3.951 and 5.033,respectively;both P<0.05).The levels of ADC and serum IGF-1 in PWML preterm infants with poor prognosis were lower than those of PWML preterm infants with good prognosis(both P<0.05).The AUC values of ADC and serum IGF-1 alone and combined in predicting the prognosis of PWML preterm infants were 0.722,0.636 and 0.950,respectively,and the AUC value of ADC combined with serum IGF-1 in predicting the prognosis of PWML preterm infants was higher than that of ADC or serum IGF-1 alone(Z= 3.887 and 5.292,respectively,both P<0.05).Conclusions The levels of ADC and IGF-1 in PWML preterm infants decrease,which are related to the severity and prognosis of PWML preterm infants.ADC and serum IGF-1 levels have certain predictive value for the diagnosis and prognosis of PWML premature infants,and their combined predictive value is higher.