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脑室周围白质损伤的新观念

Emerging concepts in periventricular white matter injury.

作者信息

Back Stephen A, Rivkees Scott A

机构信息

Department of Pediatrics, Oregon Health Science University, Portland, OR, USA.

出版信息

Semin Perinatol. 2004 Dec;28(6):405-14. doi: 10.1053/j.semperi.2004.10.010.

Abstract

Approximately 10% of newborns are born prematurely. Of these children, more than 10% will sustain neurological injuries leading to significant learning disabilities, cerebral palsy, or mental retardation, with very low birth weight infants having an even higher incidence of brain injury. Whereas intraventricular hemorrhage was the most common form of serious neurological injury a decade ago, periventricular white matter injury (PWMI) is now the most common cause of brain injury in preterm infants. The spectrum of chronic PWMI includes focal cystic necrotic lesions (periventricular leukomalacia; PVL) and diffuse myelination disturbances. Recent neuroimaging studies support that the incidence of PVL is declining, whereas diffuse cerebral white matter injury is emerging as the predominant lesion. Factors that predispose to PVL include prematurity, hypoxia, ischemia, and inflammation. It is believed that injury to oligodendrocyte (OL) progenitors contributes to the pathogenesis of myelination disturbances in PWMI by disrupting the maturation of myelin-myelin-forming oligodendrocytes. Other potential mechanisms of injury include activation of microglia and axonal damage. Chemical mediators that may contribute to white matter injury include reactive oxygen (ROS) and nitrogen species (RNS), glutamate, cytokines, and adenosine. As our understanding of the pathogenesis of PWMI improves, it is anticipated that new strategies for directly preventing brain injury in premature infants will evolve.

摘要

约10%的新生儿早产。在这些儿童中,超过10%会遭受神经损伤,导致严重的学习障碍、脑瘫或智力迟钝,极低出生体重儿的脑损伤发生率更高。十年前,脑室内出血是严重神经损伤的最常见形式,而如今脑室周围白质损伤(PWMI)是早产儿脑损伤的最常见原因。慢性PWMI的范围包括局灶性囊性坏死性病变(脑室周围白质软化症;PVL)和弥漫性髓鞘形成障碍。最近的神经影像学研究表明,PVL的发生率正在下降,而弥漫性脑白质损伤正成为主要病变。易患PVL的因素包括早产、缺氧、缺血和炎症。据信,少突胶质细胞(OL)祖细胞的损伤通过破坏髓鞘形成少突胶质细胞的成熟,导致PWMI中髓鞘形成障碍的发病机制。其他潜在的损伤机制包括小胶质细胞的激活和轴突损伤。可能导致白质损伤的化学介质包括活性氧(ROS)和氮化物(RNS)、谷氨酸、细胞因子和腺苷。随着我们对PWMI发病机制的理解不断提高,预计将出现直接预防早产儿脑损伤的新策略。

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