Hoon Alexander H, Vasconcellos Faria Andreia
Johns Hopkins University School of Medicine, Phelps Center for Cerebral Palsy and Neurodevelopmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland.
Dev Disabil Res Rev. 2010;16(4):302-12. doi: 10.1002/ddrr.127.
With advances in obstetric and perinatal management, the incidence of intraventricular hemorrhage in premature infants has declined, while periventricular leukomalacia remains a significant concern. It is now known that brain injury in children born preterm also involves neuronal-axonal disease in supratentorial and infratentorial structures. The developing brain is especially vulnerable to white matter (WM) injury from 23 to 34 weeks gestation when blood vessels serving the periventricular WM are immature. Oligodendrocyte progenitors, which are beginning to form myelin during this time, are susceptible to attack from oxygen free radicals, glutamate, and inflammatory cytokines. Advances in imaging techniques such as diffusion tensor imaging provide a more complete picture of the location and extent of injury. Effective management of children born preterm with cerebral palsy is predicated on an understanding of sequential links from etiological antecedents to brain neuropathology as revealed with neuroimaging techniques to clinical phenotypes, toward focused interventions with measurable outcomes.
随着产科和围产期管理的进步，早产儿脑室内出血的发生率有所下降，而脑室周围白质软化症仍然是一个重大问题。现在已知，早产儿童的脑损伤还涉及幕上和幕下结构的神经元轴突疾病。在妊娠23至34周时，为脑室周围白质供血的血管不成熟，发育中的大脑特别容易受到白质损伤。在此期间开始形成髓鞘的少突胶质细胞前体易受氧自由基、谷氨酸和炎性细胞因子的攻击。诸如扩散张量成像等成像技术的进步，能更全面地显示损伤的位置和程度。对早产脑瘫患儿的有效管理，基于对从病因学前驱因素到神经影像学技术所揭示的脑神经病理学，再到临床表型的连续联系的理解，从而进行有针对性的干预并取得可测量的结果。
