多动性脑瘫儿童的高胆红素血症和窒息。
Hyperbilirubinemia and Asphyxia in Children With Dyskinetic Cerebral Palsy.
机构信息
Associate Professor, Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Additional Professor, Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
出版信息
Pediatr Neurol. 2021 Jul;120:80-85. doi: 10.1016/j.pediatrneurol.2021.02.002. Epub 2021 Mar 4.
BACKGROUND
We aimed to study the clinical, etiologic, and radiological characteristics in children with dyskinetic cerebral palsy (DCP) and to compare the etiologic subtypes of hyperbilirubinemia and perinatal asphyxia.
METHODS
This is a cross-sectional, observational study that enrolled consecutive children with DCP, aged one to 14 years.
RESULTS
Sixty-five children with DCP were evaluated. Most children were boys (77%, n = 50), and term gestation (80%, n = 52). Presenting concerns were global developmental delay (97%, n = 63) and involuntary movements (60%, n = 39). Hyperbilirubinemia (66%, n = 43) and perinatal asphyxia (29%, n = 19) were the most important causes. The majority (83%, n = 54) of children were severely disabled (level V and IV). The hyperbilirubinemia group had significant motor delay (63% vs 37%, P = 0.03) and upward gaze palsy (69.7% vs 31.5%, P = 0.005) when compared with the perinatal asphyxia group. Hyperbilirubinemia significantly involved pallidi (86% vs 10% P = 0.0001) and subthalamic nucleus (26% vs none, P = 0.01), whereas asphyxia significantly involved the putamen (58% vs none, P = 0.0001), thalamus (63% vs none, P = 0.0001), and periventricular white matter (79% vs 19%, P = 0.0001).
CONCLUSIONS
DCP is the dominant type of cerebral palsy seen in term-born babies with severe dystonia, developmental delay, and motor impairment. Hyperbilirubinemia is the major cause of DCP in the study. Hyperbilirubinemia is associated with motor delay, upward gaze palsy, prominent dystonia, and involvement of globus pallidi and subthalamic nuclei.
背景
本研究旨在探讨儿童不随意运动型脑瘫（DCP）的临床、病因学和影像学特征，并比较高胆红素血症和围生期窒息的病因亚型。
方法
这是一项横断面、观察性研究，纳入了年龄在 1 至 14 岁的连续 DCP 患儿。
结果
共评估了 65 例 DCP 患儿，其中多数为男孩（77%，n=50），胎龄足月（80%，n=52）。主要表现为全面发育迟缓（97%，n=63）和不随意运动（60%，n=39）。高胆红素血症（66%，n=43）和围生期窒息（29%，n=19）是最重要的病因。大多数患儿为重度残疾（V 级和 IV 级，83%，n=54）。与围生期窒息组相比，高胆红素血症组患儿存在明显的运动延迟（63%比 37%，P=0.03）和上视运动障碍（69.7%比 31.5%，P=0.005）。高胆红素血症显著累及苍白球（86%比 10%，P=0.0001）和丘脑底核（26%比无，P=0.01），而围生期窒息显著累及壳核（58%比无，P=0.0001）、丘脑（63%比无，P=0.0001）和脑室周围白质（79%比 19%，P=0.0001）。
结论
在足月出生的重度痉挛型脑瘫患儿中，DCP 是最常见的脑瘫类型，主要表现为发育迟缓、运动障碍。本研究中，高胆红素血症是 DCP 的主要病因。高胆红素血症与运动延迟、上视运动障碍、明显的不随意运动、苍白球和丘脑底核受累有关。
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