Reimers Tonny Solveig, Ehrenfels Susanne, Mortensen Erik Lykke, Schmiegelow Marianne, Sønderkaer Signe, Carstensen Henrik, Schmiegelow Kjeld, Müller Jørn
Department of Psychology, Play Therapy, and Social Work, The Juliane Marie Center, Rigshospitalet, Copenhagen University Hospital, Denmark.
Med Pediatr Oncol. 2003 Jan;40(1):26-34. doi: 10.1002/mpo.10211.
To describe cognitive function and to evaluate the association between potentially predictive factors and cognitive outcome in an unselected population of survivors of childhood brain tumors.
We studied a consecutive sample of 133 patients (76 had received radiotherapy (RT)) who had a brain tumor diagnosed before the age of 15 years and were treated during the period January 1970 through February 1997 in the Eastern part of Denmark. Biologic effective dose of irradiation (BED) was assessed in 71 patients. One hundred twenty-seven patients were able to cooperate to WISC-R and WAIS-R. Multiple regression models were constructed to evaluate relationships between possible risk factors and cognitive outcome.
The mean intelligence (IQ) scores were substantially lower than the expected means of the general population. Younger age at diagnosis, tumor site in cerebral hemisphere, hydrocephalus treated with shunt, and treatment with RT were found to be significant predictors of lower cognitive functions. RT was the most important risk factor for impaired intellectual outcome. The mean observed full scale IQ was 97.1 (SD = 14.3) for the non-irradiated patients and 78.8 (SD = 14.3) for the irradiated patients (adjusted P < 0.001). Verbal IQ, but not performance and full scale IQ, had a significant negative correlation to BED to the tumor site (P < 0.05). These results can be used to identify subgroups of children who are at increased risk for cognitive deficits allowing early and goal-directed intervention.
描述儿童脑肿瘤幸存者未选择人群的认知功能，并评估潜在预测因素与认知结果之间的关联。
我们研究了133例患者的连续样本（76例接受了放疗（RT）），这些患者在15岁之前被诊断出患有脑肿瘤，并于1970年1月至1997年2月期间在丹麦东部接受治疗。对71例患者评估了照射的生物有效剂量（BED）。127例患者能够配合进行韦氏儿童智力量表修订版（WISC-R）和韦氏成人智力量表修订版（WAIS-R）测试。构建多元回归模型以评估可能的风险因素与认知结果之间的关系。
平均智力（IQ）得分显著低于一般人群的预期均值。诊断时年龄较小、脑半球肿瘤部位、分流治疗的脑积水以及放疗治疗被发现是认知功能较低的显著预测因素。放疗是智力结果受损的最重要风险因素。未接受照射的患者观察到的平均全量表IQ为97.1（标准差=14.3），接受照射的患者为78.8（标准差=14.3）（校正P<0.001）。言语IQ与肿瘤部位的BED有显著负相关，但操作和全量表IQ无此相关性（P<0.05）。这些结果可用于识别认知缺陷风险增加的儿童亚组，以便进行早期和有针对性的干预。
