超纵向束与早产儿和足月儿青少年认知功能障碍。
Superior longitudinal fasciculus and cognitive dysfunction in adolescents born preterm and at term.
机构信息
Department of Pediatrics, University of Texas Health Science Center, Houston, TX 77030, USA.
出版信息
Dev Med Child Neurol. 2010 Aug;52(8):760-6. doi: 10.1111/j.1469-8749.2010.03633.x. Epub 2010 Feb 24.
AIM
To understand the relationship between cognition and white-matter structure in adolescents born preterm without obvious brain injury.
METHODS
Thirty-two adolescents from a longitudinal study of child development were selected according to risk of developmental disorders at birth (born at term: eight males, five females; median age 16y 1mo, interquartile range 10mo; low risk preterm: four males, five females, median age 16y, range 4mo; high risk preterm: three males, seven females, median age 16y 2mo, range 1y 2mo) and reading ability (good: three males, eight females, median age 16y, range 7mo; average: six males, three females, median age 16y 10mo, range 1y; poor: six males, six females, median age 16y, range 6mo). Preterm birth was defined as a gestational age of 36 weeks or less and a birthweight of 1600g or less. All participants had normal clinical neuroimaging findings. We examined fractional anisotropy, radial diffusivity, and volume of three major white-matter fasciculi. The relationship between structural measures and birth risk, hemisphere, and cognitive ability (attention, lexical and sublexical decoding, auditory phonological awareness, and processing speed) were analysed using mixed-model regression.
RESULTS
Left-hemisphere superior longitudinal fasciculus (SLF) fractional anisotropy and radial diffusivity were linked to reading-related skills (fractional anisotropy vs letter-word identification, r((30))=-0.37, p<0.05; fractional anisotropy vs phoneme reversal, r((30))=-0.34, p=0.05; radial diffusivity vs letter-word identification, r((30))=0.31, p<0.10; radial diffusivity vs phoneme reversal, r((30))=0.40, p<0.05), whereas right-hemisphere SLF fractional anisotropy was related to attention skills (fractional anisotropy vs inattentiveness, r((30))=-0.38, p<0.05). SLF volume decreased as these skills declined for adolescents born preterm (volume vs phoneme reversal, r((17))=0.58, p<0.01; volume vs inattentiveness, r((17))=-0.69, p<0.01), but not for those born at term.
INTERPRETATION
The relationship between cognitive skills and SLF volume suggests that in adolescents born preterm, cryptic white-matter injury may exist, possibly related to oligodendrocyte or axonal loss, despite normal clinical neuroimaging.
目的
了解无明显脑损伤的早产儿认知与白质结构之间的关系。
方法
根据出生时发育障碍的风险，从儿童发育的纵向研究中选择了 32 名青少年（足月出生：8 名男性，5 名女性；中位年龄 16 岁 1 个月，四分位距 10 个月；低危早产儿：4 名男性，5 名女性，中位年龄 16 岁，范围 4 个月；高危早产儿：3 名男性，7 名女性，中位年龄 16 岁 2 个月，范围 1 年 2 个月）和阅读能力（好：3 名男性，8 名女性，中位年龄 16 岁，范围 7 个月；平均：6 名男性，3 名女性，中位年龄 16 岁 10 个月，范围 1 年；差：6 名男性，6 名女性，中位年龄 16 岁，范围 6 个月）。早产定义为胎龄 36 周或更小，出生体重 1600g 或更小。所有参与者均有正常的临床神经影像学表现。我们检查了三个主要白质束的分数各向异性、径向扩散和体积。使用混合模型回归分析结构测量值与出生风险、大脑半球和认知能力（注意力、词汇和次词汇解码、听觉语音意识和处理速度）之间的关系。
结果
左半球上纵束（SLF）的分数各向异性和径向扩散与阅读相关技能有关（分数各向异性与字母-单词识别，r((30))=-0.37，p<0.05；分数各向异性与语音反转，r((30))=-0.34，p=0.05；径向扩散与字母-单词识别，r((30))=0.31，p<0.10；径向扩散与语音反转，r((30))=0.40，p<0.05），而右半球 SLF 的分数各向异性与注意力技能有关（分数各向异性与注意力不集中，r((30))=-0.38，p<0.05）。尽管早产儿的临床神经影像学表现正常，但 SLF 体积随着早产儿认知技能的下降而减小（体积与语音反转，r((17))=0.58，p<0.01；体积与注意力不集中，r((17))=-0.69，p<0.01），但足月出生者则无此变化。
结论
认知技能与 SLF 体积之间的关系表明，在无明显脑损伤的早产儿中，可能存在隐匿性白质损伤，这可能与少突胶质细胞或轴突丢失有关，尽管临床神经影像学表现正常。
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