早产儿脑病的研究现状

黄志恒; 孙轶; 陈超

PDF(1007 KB)

中国当代儿科杂志 ›› 2011, Vol. 13 ›› Issue (10) : 771-775.

论著·临床研究

早产儿脑病的研究现状

黄志恒，孙轶，陈超

作者信息 +

Progress in encephalopathy of prematurity

HUANG Zhi-Heng, SUN Yi, CHEN Chao

Author information +

文章历史 +

摘要

近年来，国内外早产发生率呈不断增加的趋势。由于新生儿救治水平的提高，早产儿的存活率也在显著提高，然而幸存的早产儿容易发生脑损伤，已经成为一个严重的公共健康问题。围产期缺氧缺血、感染/炎症是早产儿脑病发生的重要因素，造成少突胶质前体细胞与皮层等处神经元的损伤。脑室周围白质的弥漫性损伤与神经元/轴突的破坏是当前早产儿脑病的重要特点，导致认知、行为障碍、脑瘫等后遗症。近年来，影像学特别是磁共振在临床诊断及随访早产儿脑病中起非常重要作用。本文总结了早产儿脑病的特点及诊断方式，以期为早产儿脑病的临床防治策略提供新的方向。

Abstract

The preterm birth has been increasing for the last decade. With the development of neonatal intensive care techniques, the survival rate of preterm infants is increased markedly. However, the brain of preterm infants is so vulnerable to injury that preterm brain injury has become an enormous public health problem. Hypoxia-ischemia and infection/inflammation are two main perinatal risk factors causing premyelinating oligodendrocyte and cortical neuron injury. Encephalopathy of prematurity is characterized by diffuse white matter injury and neuronal/axonal disruption, leading to neurological disabilities such as cognitive impairment and cerebral palsy. The advancement in imaging techniques, especially magnetic resonance imaging, provides more information for preterm brain injury and brain development, which contributes to the diagnosis and follow-up of the preterm infants. This article reviews the progress in encephalopathy of prematurity in order to open a new window to prophylaxis and management of this disease.

导出引用

黄志恒，孙轶，陈超. 早产儿脑病的研究现状[J]. 中国当代儿科杂志. 2011, 13(10): 771-775

HUANG Zhi-Heng, SUN Yi, CHEN Chao. Progress in encephalopathy of prematurity[J]. Chinese Journal of Contemporary Pediatrics. 2011, 13(10): 771-775

中图分类号： R722.1

参考文献

［1］Marlow N, Wolke D, Bracewell MA, Samara M. Neurologic and developmental disability at six years of age after extremely preterm birth［J］. NEJM, 2005, 352(1):919.

［2］中华医学会新生儿学组. 中国城市早产儿流行病学初步调查报告［J］. 中国当代儿科杂志，2005，7(1):2528.

［3］Pierson CR, Folkerth RD, Billiards SS, Trachtenberg FL, Drinkwater ME, Volpe JJ, et al. Gray matter injury associated with periventricular leukomalacia in the premature infant［J］. Acta Neuropathol, 2007, 114(6): 619631.

［4］Ment LR, Vohr BR. Preterm birth and the developing brain［J］. Lancet Neurol, 2008, 7(5):378379.

［5］Volpe JJ. Encephalopathy of prematurity includes neuronal abnormalities ［J］. Pediatrics, 2005, 116(1):221225.

［6］Kinney HC. The encephalopathy of prematurity: one pediatric neuropathologist′s perspective ［J］. Semin Pediatr Neurol, 2009, 16(4):179190.

［7］Volpe JJ. The encephalopathy of prematuritybrain injury and impaired brain development inextricably intertwined ［J］. Semin Pediatr Neurol, 2009, 16(4):167178.

［8］Volpe JJ. Brain injury in the premature infant: overview of clinical aspects, neuropathology, and pathogenesis ［J］. Semin Pediatr Neurol, 1998, 5(3):135151.

［9］Back SA. Perinatal white matter injury: the changing spectrum of pathology and emerging insights into pathogenetic mechanisms ［J］. Ment Retard Dev Disabil Res Rev, 2006, 12(2):129140.

［10］Back SA, Riddle A, McClure MM. Maturationdependent vulnerability of perinatal white matter in premature birth ［J］. Stroke, 2007, 38(2): 724730.

［11］Back SA, Han BH, Luo NL, Chricton CA, Xanthoudakis S, Tam J, et al. Selective vulnerability of late oligodendrocyte progenitors to hypoxiaischemia ［J］. J Neurosci, 2002, 22(2): 455463.

［12］Khwaja O, Volpe JJ. Pathogenesis of cerebral white matter injury of prematurity ［J］. Arch Dis Child Fetal Neonatal Ed, 2008, 93(2): F153F161.

［13］Volpe JJ, Kinney HC, Jensen FE, Rosenberg PA. The developing oligodendrocyte: key cellular target in brain injury in the premature infant ［J］. Int J Dev Neurosci, 2011, 29(4): 423440.

［14］Volpe JJ. Brain injury in premature infants: a complex amalgam of destructive and developmental disturbances ［J］. Lancet Neurol, 2009, 8(1): 110124.

［15］Deng W. Neurobiology of injury to the developing brain ［J］. Nat Rev Neurol, 2010, 6(6): 328336.

［16］Desilva TM, Billiards SS, Borenstein NS, Trachtenberg FL, Volpe JJ, Kinney HC, et al. Glutamate transporter EAAT2 expression is upregulated in reactive astrocytes in human periventricular leukomalacia ［J］. J Comp Neurol, 2008, 508(2): 238248.

［17］Huang Z, Liu J, Cheung PY, Chen C. Longterm cognitive impairment and myelination deficiency in a rat model of perinatal hypoxicischemic brain injury ［J］. Brain Res, 2009, 1301: 100109.

［18］Haynes RL, Billiards SS, Borenstein NS, Volpe JJ, Kinney HC. Diffuse axonal injury in periventricular leukomalacia as determined by apoptotic marker fractin ［J］. Pediatr Res, 2008, 63(6): 656661.

［19］Billiards SS, Haynes RL, Folkerth RD, Borenstein NS, Trachtenberg FL, Rowitch DH, et al. Myelin abnormalities without oligodendrocyte loss in periventricular leukomalacia ［J］. Brain Pathol, 2008, 18(2): 153-163.

［20］Andiman SE, Haynes RL, Trachtenberg FL, Billiards SS, Folkerth RD, Volpe JJ, et al. The cerebral cortex overlying periventricular leukomalacia: analysis of pyramidal neurons ［J］. Brain Pathol, 2010, 20(4): 803-814.

［21］Leviton A, Gressens P. Neuronal damage accompanies perinatal white-matter damage ［J］. Trends Neurosci, 2007, 30(9): 473-478.

［22］Zubiaurre-Elorza L, Soria-Pastor S, Junque C, Segarra D, Bargallo N, Mayolas N, et al. Gray matter volume decrements in preterm children with periventricular leukomalacia ［J］. Pediatr Res, 2011, 69(6): 554-560.

［23］Haynes RL, Xu G, Folkerth RD, Trachtenberg FL, Volpe JJ, Kinney HC. Potential neuronal repair in cerebral white matter injury in the human neonate ［J］. Pediatr Res, 2011, 69(1): 62-67.

［24］Talos DM, Fishman RE, Park H, Folkerth RD, Follett PL, Volpe JJ, et al. Developmental regulation of alpha-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid receptor subunit expression in forebrain and relationship to regional susceptibility to hypoxic/ischemic injury. I. Rodent cerebral white matter and cortex ［J］. J Comp Neurol, 2006, 497(1): 42-60.

［25］Lee JD, Park HJ, Park ES, Oh MK, Park B, Rha DW, et al. Motor pathway injury in patients with periventricular leucomalacia and spastic diplegia ［J］. Brain, 2011, 134(Pt 4):1199-1210.

［26］Wachtel EV, HendricksMunoz KD. Current management of the infant who presents with neonatal encephalopathy ［J］. Curr Probl Pediatr Adolesc Health Care, 2011, 41(5): 132-153.

［27］Glass HC, Bonifacio SL, Chau V, Glidden D, Poskitt K, Barkovich AJ, et al. Recurrent postnatal infections are associated with progressive white matter injury in premature infants ［J］. Pediatrics, 2008, 122(2): 299-305.

［28］Anjari M, Counsell SJ, Srinivasan L, Allsop JM, Hajnal JV, Rutherford MA, et al. The association of lung disease with cerebral white matter abnormalities in preterm infants ［J］. Pediatrics 2009, 124(1): 268-276.

［29］Malin GL, Morris RK, Khan KS. Strength of association between umbilical cord pH and perinatal and long term outcomes: systematic review and meta-analysis ［J］. BMJ, 2010, 340: c1471.

［30］中华医学会儿科学分会新生儿学组. 早产儿脑室周围-脑室内出血与脑室周围白质软化的诊断建议［J］. 中华儿科杂志, 2007, 45(1):3.

［31］O′Shea TM, Counsell SJ, Bartels DB, Dammann O. Magnetic resonance and ultrasound brain imaging in preterm infants ［J］. Early Hum Dev, 2005, 81(3): 263-271.

［32］van Wezel-Meijler G, Steggerda SJ, Leijser LM. Cranial ultrasonography in neonates: role and limitations［J］. Semin Perinatol, 2010, 34(1): 28-38.

［33］Benavente-Fernandez I, Lubian-Lopez PS, Zuazo-Ojeda MA, Jimenez-Gomez G, Lechuga-Sancho AM. Safety of magnetic resonance imaging in preterm infants［J］. Acta Paediatr, 2010, 99(6): 850-853.

［34］陈惠金. 美国神经学会新生儿神经影像指南［J］. 实用儿科临床杂志，2008，23(2):157-160.

［35］Ment LR, Hirtz D, Huppi PS. Imaging biomarkers of outcome in the developing preterm brain［J］. Lancet Neurol, 2009, 8(11): 1042-1055.

［36］Inder TE, Huppi PS, Warfield S, Kikinis R, Zientara GP, Barnes PD, et al. Periventricular white matter injury in the premature infant is followed by reduced cerebral cortical gray matter volume at term［J］. Ann Neurol, 1999, 46(5): 755-760.

［37］Shah DK, Doyle LW, Anderson PJ, Bear M, Daley AJ, Hunt RW, et al. Adverse neurodevelopment in preterm infants with postnatal sepsis or necrotizing enterocolitis is mediated by white matter abnormalities on magnetic resonance imaging at term［J］. J Pediatr, 2008, 153(2): 170-175.

［38］叶滨宾. 儿科影像诊断与临床:头颈与神经系统卷［M］. 2009:484-491.

［39］韩丽英，薛辛东，富建华. 磁共振弥散加权成像与弥散张量成像对早产儿脑白质损伤早期诊断及预后评估的研究现状［J］.中国实用儿科杂志，2011，26(1)：60-63.

［40］ElDib M, Massaro AN, Bulas D, Aly H. Neuroimaging and neurodevelopmental outcome of premature infants ［J］. Am J Perinatol, 2010, 27(10): 803-818.

［41］Kawai N, Maeda Y, Kudomi N, Yamamoto Y, Nishiyama Y, Tamiya T. Focal neuronal damage in patients with neuropsychological impairment after diffuse traumatic brain injury: evaluation using 11C-flumazenil positron emission tomography with statistical image analysis ［J］. J Neurotrauma, 2010, 27(12): 2131-2138.