日本未熟児新生児学会雑誌　第20巻　第2号　31～39頁（2008年）

日本未熟児新生児学会雑誌　20(2)：223-231；2008　

受付日：平成19．04．06

受理日：平成19．08．10

脳室周囲白質軟化症の頭部MRI所見と発達予後のロジスティック回帰分析

Logistic Regression Analysis of Brain MRI and Developmental Outcome in Periventricular Leukomalacia

岩手医科大学　小児科

Department of Pediatrics, School of Medicine, Iwate Medical University

赤坂真奈美・亀井　淳

Manami AKASAKA，Atsushi KAMEI

Key Words：Periventricular leukomalacia，brain MRI，developmental outcome，logistic regression analysis

　脳室周囲白質軟化症（PVL）児の頭部MRI所見と発達予後との関連を解析した。対象は1994年以降の10年間に当院NICUを退院し，平均（±SD）で生後15.0±7.7か月にMRI検査を行い，生後36.9±12.7か月に遠城寺式発達検査で判定したPVLの52例である。MRI所見は大脳萎縮の有無，脳室周囲白質高信号の広がり，脳室拡大の程度を数値化した。解析は運動発達または社会性・言語発達の遅れを従属変数とし，周産期情報とMRI所見を独立変数としたロジスティック回帰分析で行った。この結果，運動発達の遅れは脳室周囲白質高信号の広がり（オッズ比6.9倍）および脳室拡大の程度（同3.6倍）と，社会性・言語発達の遅れは大脳萎縮（同7.7倍）と有意な関連が認められた。PVL児の頭部MRI所見は発達予後の予測に有用と考えられた。

　The aim of this study was to evaluate the correlation between brain MRI findings and developmental outcome in periventricular leukomalacia. The study included 52 children discharged from our NICU between 1994 and 2004. The children underwent MRI at an average age of 15.0±7.7（SD）months and had evidence of periventricular leukomalacia. The cognitive assessment was made using the Enjyoji Infant and Toddler Analytical Development Test at an average age of 36.9±12.7 months. The MRI findings were re-evaluated for the presence of cerebral atrophy, the extent of hyperintensity in the periventricular white matter, and the degree of ventricular enlargement. Logistic regression analysis was conducted using the motor or adaptive-social behavior and language developmental delay as a dependent variable, and the perinatal factors and MRI findings as independent variables. The motor developmental delay was significantly associated with the extent of hyperintensity in the periventricular white matter（odds ratio, 6.9）and the degree of ventricular enlargement（odds ratio, 3.6）. The adaptive-social behavior and language developmental delay was significantly associated with cerebral atrophy（odds ratio, 7.7）. Therefore, MRI findings could be useful in predicting motor as well as adaptive-social behavior and language developmental outcome of children complicated with periventricular leukomalacia.