Department of Neurology, University of New Mexico, Albuquerque, New Mexico.
Department of Psychology, University of New Mexico, Albuquerque, New Mexico.
Pediatr Res. 2017 Oct;82(4):685-690. doi: 10.1038/pr.2017.130. Epub 2017 Jun 21.
BackgroundIn premature children, erythropoiesis-stimulating agents (ESAs) may improve developmental outcome. It is not clear which of the several potential mechanisms are responsible for this improvement. High-resolution MRI and diffusion tensor imaging characterize brain structure and white matter organization, offering possible insight into the long-term effect of ESAs on brain development.MethodsMRI scans were performed at 3.5-4 years of age on former preterm infants treated with ESAs or placebo, and on healthy term controls. Mean cortical thickness, surface area, and fractional anisotropy (FA) were compared across study groups, and were correlated with general IQ measures.ResultsUnivariate analysis found no significant effect of ESAs on cortical thickness (P=0.366), surface area (P=0.940), or FA (P=0.150); however, there was a greater increase in FA among ESA-treated girls. Group analysis found significant correlations between FA and Full-Scale IQ (P=0.044) and Verbal IQ (P=0.036), although there was no significant relationship between Full-Scale IQ and FA among just the preterm children.ConclusionESA treatment may have a preferential effect on white matter development in girls, although factors other than just whole-brain FA are involved in mediating cognitive outcome.
在早产儿中，促红细胞生成素刺激剂（ESAs）可能改善发育结局。但目前尚不清楚是哪些潜在机制导致了这种改善。高分辨率 MRI 和弥散张量成像可以描绘脑结构和白质组织，为 ESA 对脑发育的长期影响提供可能的见解。
对接受 ESA 或安慰剂治疗的既往早产儿和健康足月对照者进行了 3.5-4 岁时的 MRI 扫描。比较了研究组之间的平均皮质厚度、表面积和各向异性分数（FA），并将其与一般智商测量值相关联。
单变量分析发现 ESA 对皮质厚度（P=0.366）、表面积（P=0.940）或 FA（P=0.150）均无显著影响；然而，ESA 治疗的女孩 FA 增加幅度更大。组分析发现 FA 与全量表智商（P=0.044）和言语智商（P=0.036）显著相关，但仅在早产儿中，全量表智商与 FA 之间没有显著关系。
ESA 治疗可能对女孩的白质发育有优先作用，但除了全脑 FA 之外，还有其他因素参与了认知结果的介导。
