Peterson B S, Vohr B, Staib L H, Cannistraci C J, Dolberg A, Schneider K C, Katz K H, Westerveld M, Sparrow S, Anderson A W, Duncan C C, Makuch R W, Gore J C, Ment L R
Yale Child Study Center, 230 S Frontage Rd, New Haven, CT 06520, USA.
JAMA. 2000 Oct 18;284(15):1939-47. doi: 10.1001/jama.284.15.1939.
Preterm infants have a high prevalence of long-term cognitive and behavioral disturbances. However, it is not known whether the stresses associated with premature birth disrupt regionally specific brain maturation or whether abnormalities in brain structure contribute to cognitive deficits.
To determine whether regional brain volumes differ between term and preterm children and to examine the association of regional brain volumes in prematurely born children with long-term cognitive outcomes.
Case-control study conducted in 1998 and 1999 at 2 US university medical schools.
A consecutive sample of 25 eight-year-old preterm children recruited from a longitudinal follow-up study of preterm infants and 39 term control children who were recruited from the community and who were comparable with the preterm children in age, sex, maternal education, and minority status.
Volumes of cortical subdivisions, ventricular system, cerebellum, basal ganglia, corpus callosum, amygdala, and hippocampus, derived from structural magnetic resonance imaging scans and compared between preterm and term children; correlations of regional brain volumes with cognitive measures (at age 8 years) and perinatal variables among preterm children.
Regional cortical volumes were significantly smaller in the preterm children, most prominently in sensorimotor regions (difference: left, 14.6%; right, 14.3% [P<.001 for both]) but also in premotor (left, 11.2%; right, 12.6% [P<.001 for both]), midtemporal (left, 7.4% [P =.01]; right, 10.2% [P<.001]), parieto-occipital (left, 7.9% [P =.01]; right, 7.4% [P =.005]), and subgenual (left, 8.9% [P =.03]; right, 11.7% [P =.01]) cortices. Preterm children's brain volumes were significantly larger (by 105. 7%-271.6%) in the occipital and temporal horns of the ventricles (P<. 001 for all) and smaller in the cerebellum (6.7%; P =.02), basal ganglia (11.4%-13.8%; P</=.005), amygdala (left, 20.2% [P =.001]; right, 30.0% [P<.001]), hippocampus (left, 16.0% [P =.001]; right, 12.0% [P =.007]), and corpus callosum (13.1%-35.2%; P</=.01 for all). Volumes of sensorimotor and midtemporal cortices were associated positively with full-scale, verbal, and performance IQ scores (P<.01 for all).
Our data indicate that preterm birth is associated with regionally specific, long-term reductions in brain volume and that morphological abnormalities are, in turn, associated with poorer cognitive outcome. JAMA. 2000;284:1939-1947.
早产儿长期认知和行为障碍的患病率很高。然而，尚不清楚与早产相关的应激是否会破坏区域特异性脑成熟，或者脑结构异常是否会导致认知缺陷。
确定足月儿和早产儿的脑区体积是否存在差异，并研究早产儿童脑区体积与长期认知结果之间的关联。
1998年和1999年在美国两所大学医学院进行的病例对照研究。
从一项早产儿纵向随访研究中连续抽取25名8岁早产儿，以及从社区招募的39名足月儿作为对照，这些足月儿在年龄、性别、母亲教育程度和少数族裔身份方面与早产儿相当。
通过结构磁共振成像扫描得出的皮质亚区、脑室系统、小脑、基底神经节、胼胝体、杏仁核和海马体的体积，并在早产儿和足月儿之间进行比较；早产儿童脑区体积与认知指标（8岁时）和围产期变量之间的相关性。
早产儿的区域皮质体积明显较小，最明显的是感觉运动区域（差异：左侧14.6%；右侧14.3%[两者P<.001]），但在运动前区（左侧11.2%；右侧12.6%[两者P<.001]）、颞中区（左侧7.4%[P =.01]；右侧10.2%[P<.001]）、顶枕区（左侧7.9%[P =.01]；右侧7.4%[P =.005]）和膝下区（左侧8.9%[P =.03]；右侧11.7%[P =.01]）皮质也较小。早产儿脑室枕角和颞角的脑体积明显更大（增加105.7%-271.6%）（所有P<.001），而小脑（6.7%；P =.02）、基底神经节（11.4%-13.8%；P≤.005）、杏仁核（左侧20.2%[P =.001]；右侧30.0%[P<.001]）、海马体（左侧16.0%[P =.001]；右侧12.0%[P =.007]）和胼胝体（13.1%-35.2%；所有P≤.01）的体积较小。感觉运动和颞中区皮质的体积与全量表、语言和操作智商得分呈正相关（所有P<.01）。
我们的数据表明，早产与脑体积的区域特异性长期减少有关，而形态学异常反过来又与较差的认知结果有关。《美国医学会杂志》。2000年；284:1939 - 1947。
