Section of Neonatology, Department of Pediatrics, Rush University Medical Center, Chicago, IL, USA.
Division of Neonatology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
Semin Fetal Neonatal Med. 2018 Dec;23(6):411-415. doi: 10.1016/j.siny.2018.08.008. Epub 2018 Sep 6.
Necrotizing enterocolitis (NEC), a leading cause of morbidity and mortality in preterm neonates, is a devastating disease characterized by intestinal tissue inflammation and necrosis. NEC pathogenesis is multifactorial but remains unclear. Translocation of bacteria and/or bacterial products across a weak intestinal barrier in the setting of impaired mucosal immunity leads to an exaggerated inflammatory response and secondary mucosal epithelial injury. In addition to prematurity, other risk factors for NEC include congenital heart disease, maternal pre-eclampsia with placental vascular insufficiency, severe anemia and blood transfusion - all conditions that predispose the intestine to ischemia. We recently found that maldevelopment of the intestinal microvasculature plays an important role in NEC pathogenesis. Here we review the evidence supporting a role for defective development of the intestinal mucosal microvasculature and perturbations of intestinal blood flow in NEC, emphasizing the importance of vascular endothelial growth factor (VEGF) and the VEGF receptor-2 signaling pathway.
新生儿坏死性小肠结肠炎（NEC）是导致早产儿发病率和死亡率的主要原因，是一种以肠道组织炎症和坏死为特征的破坏性疾病。NEC 的发病机制是多因素的，但仍不清楚。在黏膜免疫受损的情况下，细菌和/或细菌产物穿过薄弱的肠屏障易位，导致过度的炎症反应和继发性黏膜上皮损伤。除早产外，NEC 的其他危险因素还包括先天性心脏病、胎盘血管功能不全的子痫前期、严重贫血和输血——所有这些都会使肠道容易发生缺血。我们最近发现，肠道微血管的发育不良在 NEC 的发病机制中起着重要作用。在这里，我们回顾了支持肠道黏膜微血管发育不良缺陷和肠道血流紊乱在 NEC 中的作用的证据，强调了血管内皮生长因子（VEGF）和 VEGF 受体-2 信号通路的重要性。
