目的 分析脑性瘫痪儿童共病智力障碍及严重程度的危险因素,为临床早期干预及个性化治疗方案的制定提供依据。 方法 选取2015年1月—2024年11月于佳木斯大学附属第三医院住院的1~16岁脑瘫患儿392例作为研究对象,男270例,女122例。收集患儿临床资料与Gesell发育诊断量表(GDS)、韦氏幼儿智力量表第四版(WPPSI-Ⅳ)/中国儿童韦氏智力测验第四版(WISC-Ⅳ)、粗大运动功能分级系统(GMFCS)评估结果,进行回顾性分析。根据发育商/智商,将患儿的智力程度分为正常、轻度、中度和重度。采用χ2检验进行单因素分析,比较组间差异,筛选出具有显著性意义的因素,纳入有序多分类logistic回归分析,以探究影响脑瘫患儿智力障碍严重程度的危险因素。 结果 单因素分析发现4组患儿间早产史(χ2=6.476)、高胆红素血症史(χ2=17.248)、GMFCS Ⅳ~Ⅴ级(χ2=117.291)、痉挛型四肢瘫(χ2=32.023)和妊娠期用药史(χ2=36.695)比较差异有统计学意义(P<0.05)。有序多分类logistic回归分析发现,高胆红素血症史(OR=2.465,95%CI:1.619~3.747)、早产史(OR=1.478,95%CI:1.002~2.181)及GMFCS Ⅳ~Ⅴ级(OR=10.166,95%CI:6.166~16.743)是增加脑瘫儿童智力障碍严重程度的影响因素(P<0.05)。结论 高胆红素血症史、早产史及 GMFCS Ⅳ~Ⅴ级会加重脑瘫合并智力障碍儿童的病情,建议加强高危因素监测,对高风险儿童定期评估,实施早期干预,依据不同病情制定个性化康复干预方案,促进儿童神经功能良好发育。
Abstract
Objective To analyze the risk factors for comorbid intellectual disability (ID) and its severity in children with cerebral palsy (CP), so as to provide evidence for early clinical intervention and personalized treatment plans. Methods A retrospective study was conducted on 392 children with CP (aged 1 - 16 years, 270 males and 122 females) hospitalized at the Third Affiliated Hospital of Jiamusi University from January 2015 to November 2024.Clinical data and assessment results from the Gesell Developmental Scale (GDS), Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition (WPPSI-IV)/Wechsler Intelligence Scale for Children-Chinese Fourth Edition (WISC-IV), and Gross Motor Function Classification System (GMFCS) were retrospectively collected.Intellectual function was categorized as normal, mild, moderate, or severe based on developmental quotient (DQ)/intelligence quotient (IQ).χ2test was used for univariate analysis to compare intergroup differences and identify significant factors, followed by ordinal logistic regression to determine risk factors influencing ID severity in CP children. Results Univariate analysis revealed significant differences among the four groups in the proportions of preterm birth history (χ2=6.476), hyperbilirubinemia history (χ2=17.248), GMFCS level IV-V (χ2=117.291), spastic quadriplegia (χ2=32.023), and maternal medication use during pregnancy (χ2=36.695) (all P<0.05).Ordinal logistic regression identified hyperbilirubinemia history (OR=2.465, 95% CI: 1.619 - 3.747), preterm birth history (OR=1.478, 95% CI: 1.002 - 2.181), and GMFCS level Ⅳ-Ⅴ (OR=10.166, 95% CI: 6.166 - 16.743) as independent risk factors for increased ID severity in CP children (P<0.05). Conclusions Hyperbilirubinemia history, preterm birth, and severe motor impairment (GMFCS Ⅳ-Ⅴ) exacerbate intellectual disability in children with CP.Strengthened monitoring of high-risk factors, regular assessments, early intervention, and tailored rehabilitation programs are recommended to promote optimal neurodevelopmental outcomes.
关键词
脑性瘫痪 /
智力障碍 /
高胆红素血症 /
早产 /
粗大运动功能分级系统
Key words
cerebral palsy /
intellectual disability /
neonatal hyperbilirubinemia /
preterm birth /
Gross Motor Function Classification System
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基金
国家自然科学基金(81300122);黑龙江省省属高等学校基本科研业务费团队项目(2022-KYYWF-0653);佳木斯大学东极学术团队“儿童智能康复团队(DJXSTD202413);2024年度黑龙江省自然科学基金联合基金培育项目(PL2024H014)
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