Division of Pediatric Nephrology, Department of Pediatrics, Holtz Children's Hospital, University of Miami Miller School of Medicine, Miami, FL 33101, USA.
Nat Rev Nephrol. 2012 Feb 28;8(5):265-74. doi: 10.1038/nrneph.2012.38.
Infants born prematurely at <37 weeks' gestation account for over 80% of infants weighing <2,500 g at birth-low birth weight (LBW) infants. This designation remains the surrogate marker for developmental origins of adult disease. Landmark studies spanning four decades have shown that individuals born with a LBW are more likely to develop cardiovascular and renal disease in later life, which is believed to be related to 'developmental programming' of such adult disease during vulnerable periods of growth in utero and in the early postnatal period. There has long been ambiguity regarding the distinction between infants with intrauterine growth restriction and preterm infants since both show a low nephron endowment that is associated with subsequent hypertension and chronic kidney disease. Knowledge is growing specific to the preterm infant and the developmental associations of being born preterm with the interruption of normal organogenesis relative to the vascular tree and kidney. Both systems develop by branching morphogenesis and interruptions lead to considerable deficits in their structure and function. These developmental aberrations can lead to endothelial dysfunction, hypertension, proteinuria and metabolic abnormalities that persist throughout life. This Review will examine the effect of preterm birth on the development of cardiovascular and kidney disease in later life and will also discuss potential early interventions to alter the progression of disease.
出生胎龄小于 37 周的早产儿占出生体重小于 2500g 的婴儿的 80%以上-低出生体重（LBW）儿。这一指标仍然是成人疾病发育起源的替代标志物。跨越四个十年的里程碑式研究表明，LBW 出生的个体在以后的生活中更有可能患上心血管和肾脏疾病，这被认为与宫内和出生后早期生长过程中的“发育编程”有关，在这些脆弱时期，这些成年疾病的发育受到了影响。由于宫内生长受限的婴儿和早产儿都表现出低肾小球数量，这与随后的高血压和慢性肾脏病有关，因此长期以来，人们一直对这两者之间的区别存在混淆。目前，人们对早产儿的了解越来越多，也越来越了解与早产相关的发育关联，即相对于血管树和肾脏，早产会中断正常的器官发生。这两个系统都是通过分支形态发生发育的，中断会导致它们的结构和功能出现相当大的缺陷。这些发育异常会导致内皮功能障碍、高血压、蛋白尿和代谢异常，这些异常会持续终生。这篇综述将探讨早产儿出生对成年后心血管和肾脏疾病发展的影响，并将讨论潜在的早期干预措施，以改变疾病的进展。
