中国神经再生研究(英文版) ›› 2017, Vol. 12 ›› Issue (6): 890-896.doi: 10.4103/1673-5374.208547

• 综述:神经损伤修复保护与再生 • 上一篇    下一篇

早产新生儿系统性炎症的神经系统后果

  

  • 收稿日期:2017-05-23 出版日期:2017-06-15 发布日期:2017-06-15

 Neurological consequences of systemic inflammation in the premature neonate

Aparna Patra, Hong Huang, John A. Bauer, Peter J. Giannone   

  1. OMNI Academic Service Line and Division of Neonatology, Department of Pediatrics, Kentucky Children’s Hospital, College of Medicine, University of Kentucky, Lexington, KY, USA
  • Received:2017-05-23 Online:2017-06-15 Published:2017-06-15
  • Contact: Aparna Patra, M.D., aparna.patra@uky.edu.

摘要:

尽管在过去二十年来新生儿保健方面取得了实质性的进展,并且“极早”早产儿的生存率得到提高,但极早熟仍然与长期的神经发育障碍有关。脑白质损伤是早产大脑中的主要形式,会导致多种不良神经系统结果。这种脑损伤模式和不利的神经系统后遗症在暴露于全身炎症状况的早产儿中很常见,例如临床或培养结果证实的败血症,伴有或不伴有脑膜炎,长时间的机械通气,支气管肺发育不良,坏死性小肠结肠炎和绒毛膜羊膜炎。基础机制可能包括细胞因子介导的过程,而不会病原体直接进入脑内,发育差异中的免疫反应和复杂的神经血管屏障系统在调节早产儿各种全身性炎症损害的脑反应中发挥关键作用。基于血清生物标志物或脑成像发现的磁共振成像了解这些病理机制和这种损伤的临床相关性将为未来发育中大脑的研究和翻译治疗机会铺平道路。

ORCID:0000-0003-2433-9335(Aparna Patra)

Abstract:

Despite substantial progress in neonatal care over the past two decades leading to improved survival of extremely premature infants, extreme prematurity continues to be associated with long term neurodevelopmental impairments. Cerebral white matter injury is the predominant form of insult in preterm brain leading to adverse neurological consequences. Such brain injury pattern and unfavorable neurologic sequelae is commonly encountered in premature infants exposed to systemic inflammatory states such as clinical or culture proven sepsis with or without evidence of meningitis, prolonged mechanical ventilation, bronchopulmonary dysplasia, necrotizing enterocolitis and chorioamnionitis. Underlying mechanisms may include cytokine mediated processes without direct entry of pathogens into the brain, developmental differences in immune response and complex neurovascular barrier system that play a critical role in regulating the cerebral response to various systemic inflammatory insults in premature infants. Understanding of these pathologic mechanisms and clinical correlates of such injury based on serum biomarkers or brain imaging findings on magnetic resonance imaging will pave way for future research and translational therapeutic opportunities for the developing brain.

Key words: extremely premature infants, systemic inflammation, white matter injury, neurodevelopmental impairment, cytokines