The Ritchie Centre, Hudson Institute of Medical Research and Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia.
Oregon National Primate Research Center, Oregon Health & Science University, Portland, OR, USA.
J Physiol. 2018 Dec;596(23):5593-5609. doi: 10.1113/JP275595. Epub 2018 Jul 21.
This review covers our current knowledge of the causes of perinatal brain injury leading to cerebral palsy-like outcomes, and argues that much of this brain damage is preventable. We review the experimental evidence that there are treatments that can be safely administered to women in late pregnancy that decrease the likelihood and extent of perinatal brain damage that occurs because of acute and severe hypoxia that arises during some births, and the additional impact of chronic fetal hypoxia, infection, inflammation, growth restriction and preterm birth. We discuss the types of interventions required to ameliorate or even prevent apoptotic and necrotic cell death, and the vulnerability of all the major cell types in the brain (neurons, astrocytes, oligodendrocytes, microglia, cerebral vasculature) to hypoxia/ischaemia, and whether a pan-protective treatment given to the mother before birth is a realistic prospect.
这篇综述涵盖了导致类似脑瘫的围产期脑损伤的原因，我们认为，其中许多脑损伤是可以预防的。我们回顾了实验证据，表明有一些治疗方法可以安全地用于妊娠晚期的妇女，以降低因某些分娩时发生的急性和严重缺氧引起的围产期脑损伤的可能性和程度，以及慢性胎儿缺氧、感染、炎症、生长受限和早产的额外影响。我们讨论了减轻甚至预防细胞凋亡和坏死的干预类型，以及大脑中所有主要细胞类型（神经元、星形胶质细胞、少突胶质细胞、小胶质细胞、脑血管）对缺氧/缺血的易感性，以及在出生前给予母亲全面保护的治疗是否具有现实前景。
