极早产儿和/或极低出生体重儿对青少年时脑体积影响的Meta分析

摘要

目的 评估极早产和/或极低出生体重对青少年时脑体积的影响.方法 系统检索PubMed、EMBASE、the Cochrane Library、Web of Science、中国生物医学文献(CBM)、万方和知网(CNKI)数据库,检索时间从建库至2017年10月20日,纳入暴露组为出生胎龄≤32周和/或出生体重≤1500 g、非暴露组为出生胎龄38～42周且出生体重≥2500 g、队列终点(13～18岁)时使用MRI行脑体积测量的队列研究,排除出生时存在先天畸形或其他先天性疾病、随访期间存在可能影响测量结果的疾病及无法提取本文设定的测量指标(全脑、白质、灰质、小脑、海马和胼胝体的体积)的文献.采用NOS量表评价文献质量,R 3.4.0软件进行Meta分析,I2检验文献异质性.结果 13篇英文文献(n=1272)进入本文Meta分析,暴露组686例,非暴露组586例.13篇文献均随访不完整,9篇非暴露组与暴露组来源于同社区,3篇仅根据问卷回顾出生数据.13篇文献均描述采用1.5T场强的MRI、计算机软件自动测量体积,暴露组和非暴露组队列终点年龄均一致.Meta分析结果显示,暴露组与非暴露组相比,全脑(SMD=-0.66,95％CI=-0.81～-0.51)、白质(SMD=-0.51,95％CI=-0.64～-0.38)、灰质(SMD=-0.60,95％CI=-0.93～-0.28)、小脑(SMD=-0.45,95％CI=-0.64～-0.25)、海马(SMD=-0.48,95％CI=-0.73～-0.24)和胼胝体均(SMD=-0.43,95％CI=-0.63～-0.24)明显缩小,差异均有统计学意义.全脑和白质体积的Meta分析漏斗图检验未见发表偏倚.结论 极早产和/或极低出生体重儿青少年岁时的脑整体体积和特定脑区域体积降低.%Objective To evaluate the effects of very preterm birth ( born≤32 weeks of gestation ) and/or very low birth-weight ( VLBW, birth weight ≤ 1500 g ) on brain volume development during adolescence of 13 to 18 years old. Methods Databases including PubMed, EMBASE, the Cochrane Library, Web of Science, Chinese Biomedical Database ( CBM) , WanFang Data and CNKI from inception to October 20, 2017 were searched for studies that reported volumetric outcomes in adolescents using magnetic resonance imaging, including cohort studies in which experimental groups were born with gestational age ≤32 weeks and / or birth weight≤1500 g, control group with gestational age of 38 to 42 weeks and birth weight≥2500 g, and excluding studies with congenital malformations or diseases at birth, presence of disease that may affect measurement outcome during follow-up, and studies failure to extract the measurements herein. The outcome indicators were whole brain, white matter and gray matter, cerebellum, hippocampal and corpus callosum volume. The quality of the literature was evaluated with Newcastle-Ottawa scale ( NOS) and meta-analysis was conducted with R 3.4.0 software, and the heterogeneity among the studies was assessed by I2 test. ResuIts Thirteen English studies ( n=1272) entered the meta-analysis, including 686 cases in the experimental group and 586 cases in the control group. None of the 13 studies was followed completely. In 9 studies non-exposed and exposed groups were not from the same community. 3 studies were only based on retrospective questionnaire. All of the 13 studies used MRI with field strength of 1.5T, computer software to measure the volume automatically, and the same endpoint age for both cohorts. Meta-analysis showed that compared with the control group, the whole brain volume (SMD=-0.66, 95％CI: -0.81--0.51), white matter volume (SMD=-0.51, 95％CI: -0.64--0.38), gray matter volume (SMD=-0.60, 95％CI: -0.93--0.28), Cerebellum volume ( SMD=-0.45, 95％CI:-0.64--0.25) , hippocampus volume ( SMD=-0.48, 95％CI:-0.73--0.24) and corpus callosum volume ( SMD=-0.43, 95％CI:-0.63--0.24) in the experimental group were significantly reduced, respectively. Meta-analysis of whole-brain and white matter volume using funnel plot tests did not find publication bias.ConcIusion Very preterm birth and very low birth weight have a significant negative effect on volumes of whole brain and specific region of brain in adolescents.