不同胎龄早产儿振幅整合脑电图差异及与呼吸窘迫综合征的相关性分析

Analysis of the differences in amplitude-integrated electroencephalogram among preterm infants of different gestational ages and its correlation with respiratory distress syndrome

摘要

目的 分析不同胎龄早产儿振幅整合脑电图(aEEG)差异及与呼吸窘迫综合征(RDS)的相关性。方法 选取2021年3月至2024年3月于秦皇岛市妇幼保健院出生的102例早产儿为研究对象,按照胎龄分为早期组(28~31⁺⁶周,n=18)、中期组(32~33⁺⁶周,n=34)、晚期组(34~36⁺⁶周,n=50)。根据是否符合RDS诊断标准将所有早产儿分为RDS组(n=30)与非RDS组(n=72)。采用多元线性回归分析胎龄与aEEG相关指标的相关性。采用Logistic回归分析不同胎龄早产儿aEEG相关指标与RDS的关联性。应用Logistic回归模型结合限制性立方样条模型(RCS)分析早产儿aEEG相关指标与RDS发生风险的剂量反应关系。结果 多元线性回归分析显示,胎龄与aEEG指标电压连续性出现频率、活动睡眠(AS)上界及下界振幅电压、安静睡眠(QS)上界及下界振幅电压呈显著正相关性(β值介于2.537~2.831之间,P<0.05),与睡眠-觉醒周期呈显著负相关性(β=-1.873,P<0.05);不同胎龄中早产儿电压连续性、AS上界及下界振幅电压、QS上界及下界振幅电压为RDS的保护因素(OR值介于0.459~0.542之间,P<0.05),睡眠-觉醒周期为危险因素(OR值介于3.189~3.420之间,P<0.05);RCS分析显示,AS上界及下界振幅电压、QS上界及下界振幅电压与RDS之间存在显著负相关趋势及非线性剂量反应关系(整体关联性检验χ²值介于22.158~31.849之间,P<0.05;非线性检验χ²值介于7.580~8.721之间,P<0.05),睡眠-觉醒周期与之呈显著正相关趋势及非线性关系(整体关联性检验χ²=18.925,P<0.05;非线性检验χ²=9.130,P<0.05)。结论 振幅整合脑电图可有效评估早产儿脑部成熟度,早产儿脑电背景活动随胎龄的增加而趋于成熟,并且振幅整合脑电图与早产儿呼吸窘迫综合征的发生具有显著相关性。

Abstract

Objective To analyze the differences in amplitude-integrated electroencephalogram (aEEG) among preterm infants of different gestational ages and its correlation with respiratory distress syndrome (RDS). Methods A total of 102 preterm infants born in matemily and child care center of Qinhuangdao from March 2021 to March 2024 were selected as the research subjects and divided into early group (28-31 ⁺⁶ weeks,n=18),middle group (32-33 ⁺⁶ weeks,n=34),and late group (34-36 ⁺⁶ weeks,n=50) based on gestational age.All preterm infants were classified into RDS group (n=30) and non-RDS group (n=72) according to whether they met the diagnostic criteria for RDS.Multiple linear regression was used to analyze the correlation between gestational age and aEEG-related indicators.Logistic regression was used to analyze the association between aEEG-related indicators of preterm infants of different gestational ages and RDS.A logistic regression model combined with restricted cubic spline (RCS) was applied to analyze the dose-response relationship between aEEG-related indicators of preterm infants and the risk of RDS. Results Multiple linear regression analysis showed that gestational age was significantly positively correlated with the frequency of voltage continuity,upper and lower boundary amplitude voltages of active sleep (AS),and upper and lower boundary amplitude voltages of quiet sleep (QS) in aEEG (β ranged from 2.537 to 2.831,P<0.05),and significantly negatively correlated with sleep-wake cycle (β=-1.873,P<0.05).In different gestational ages,voltage continuity,upper and lower boundary amplitude voltages of AS,and upper and lower boundary amplitude voltages of QS were protective factors for RDS (OR ranged from 0.459 to 0.542,P<0.05),while sleep-wake cycle was a risk factor (OR ranged from 3.189 to 3.420,P<0.05).RCS analysis showed that upper and lower boundary amplitude voltages of AS and QS had a significant negative correlation trend and nonlinear dose-response relationship with RDS (overall association χ ² ranged from 22.158 to 31.849,P<0.05;nonlinear χ ² ranged from 7.580 to 8.721,P<0.05),and sleep-wake cycle had a significant positive correlation trend and nonlinear relationship with RDS (overall association χ ²=18.925,P<0.05;nonlinear χ ²=9.130,P<0.05). Conclusion Amplitude-integrated electroencephalogram can effectively evaluate the brain maturity of preterm infants.The background activity of electroencephalogram in preterm infants tends to mature with the increase of gestational age,and amplitude-integrated electroencephalogram is significantly correlated with the occurrence of respiratory distress syndrome in preterm infants.

关键词

早产儿 / 振幅整合脑电图 / 呼吸窘迫综合征 / 相关性

Key words

preterm infant / amplitude-integrated electroencephalogram / respiratory distress syndrome / correlation

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基金资助

秦皇岛市科学技术研究与发展计划任务书(202301A246)