功能性近红外光谱成像联合全身运动质量评估对脑损伤高危儿神经发育结局的预测价值-东南大学学报医学版

功能性近红外光谱成像联合全身运动质量评估对脑损伤高危儿神经发育结局的预测价值

单位：1. 邢台市中心医院新生儿科, 河北邢台 054001;
2. 邢台市中心医院康复医学科, 河北邢台 054001;
3. 邢台市中心医院科教科, 河北邢台 054001

分类号：R726.511

出版年·卷·期（页码）：2026·45·第四期（575-580）

摘要：

目的:探究全身运动(GMs)质量评估联合功能性近红外光谱成像(fNIRS)对脑损伤高危儿神经发育结局的预测价值。方法:选取2022年1月至2024年1月邢台市中心医院收治的224例早产脑损伤高危儿。矫正胎龄足月后6~9周时进行扭动运动GMs质量评估,矫正胎龄足月后15~20周时进行不安运动GMs质量评估。矫正12月龄时依据小儿脑瘫及发育商情况明确患儿神经发育结局,ROC曲线分析fNIRS、GMs质量评估在患儿中的预测效度。结果:获得完整随访的脑损伤高危儿共192例,其中发育正常151例,发育迟缓36例,脑瘫5例;扭动运动GMs质量评估在神经发育结局预测中的灵敏度为70.73%,特异度为93.38%;不安运动GMs质量评估预测的灵敏度为85.37%,特异度为97.35%;单项fNIRS预测灵敏度为75.00%,特异度为94.59%;神经发育异常组fNIRS、GMs质量评估异常检出率均显著高于正常组(P＜0.05);采用并联(平行)联合方案后,fNIRS+不安运动GMs质量评估联合检测灵敏度升至88.64%,特异度为96.02%(较单项GMs质量评估特异度轻度下降),整体预测效能优于任一单一检测指标(P＜0.05)。结论:早产脑损伤患儿神经发育异常风险显著增高。不安运动阶段GMs质量评估对神经发育结局预测价值更高,联合fNIRS检测可进一步提升预测效能。

Objective: To explore the predictive performance of functional near-infrared spectroscopy(fNIRS) combined with general movements(GMs) quality assessment for neurodevelopmental outcomes in high-risk preterm infants with brain injury. Methods: A total of 224 premature infants with high risk of brain injury hospitalized at Xingtai Central Hospital from January 2022 to January 2024 were enrolled prospectively. GMs assessment for writhing movements was conducted at 6-9 weeks of corrected gestational age, and GMs assessment for fidgety was performed at 15-20 weeks of corrected gestational age. Neurodevelopmental outcomes were confirmed at 12 months of corrected age based on cerebral palsy condition and developmental quotient of infants. ROC curve analysis was adopted to o compare the predictive validity of fNIRS and GMs assessment alone and in combination. Results: Complete follow-up data were obtained from 192 high risk infants with brain injury, among whom 151 had normal neurodevelopment and 41 presented abnormal neurodevelopment(36 with developmental delay and 5 with cerebral palsy). For predicting adverse neurodevelopmental outcomes, movements GMs yielded a sensitivity of 70.73% and specificity of 93.38%; fidgety movements GMs achieved a sensitivity of 85.37% and specificity of 97.35%. Single fNIRS testing had a sensitivity of 75.00% and the specificity of 94.59%. The abnormal positive rates of fNIRS and GMs abnormalities in the neurodevelopmental abnormal group were significantly higher than those in the normal group(P<0.05). Parallel combined detection of fNIRS and fidgety movements GMs elevated the sensitivity to 88.64%, with a specificity of 96.02%(slightly decreased compared with single fidgety movements GMs). The combined model exhibited significantly superior overall predictive efficacy relative to any single detection indicator(P<0.05). Conclusion: GMs assessment at the fidgety movement stage has stronger predictive value for neurodevelopmental outcomes in preterm infants with brain injury; combined application with fNIRS can further improve predictive performance.

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