Millicovsky G, Lazar M L
Department of Clinical Research, Medical City Dallas Hospital, Texas, USA.
Obstet Gynecol. 1995 Aug;86(2):300-1. doi: 10.1016/0029-7844(95)00141-d.
Spina bifida is one of the most common human birth defects. In fetuses with open spina bifida, the spinal cord remains exposed to the amniotic fluid (AF) throughout gestation. Results of prenatal examinations suggest that affected fetuses exhibit leg movement until the third trimester but become paralyzed later in pregnancy, several months after the initial spinal cord defect occurred. Clinical observations suggest that after the initial defect in neural tube closure, the spinal cord may be subjected to continuous, progressive damage related to contact with the AF. We urge clinicians and scientists to test the AF damage hypothesis by studying prenatal fetal activity in humans and through experimental studies. If this hypothesis is correct, the onset of spinal paralysis in affected fetuses may be prevented by protecting the spinal cord tissues before major nerve damage occurs. If the course of this disease process could be altered, both the patient and family would benefit from the reduction in the misery of the disabling neurologic condition as well as from the acute and long-term cost of medical care.
脊柱裂是人类最常见的出生缺陷之一。在患有开放性脊柱裂的胎儿中，整个妊娠期脊髓都暴露于羊水（AF）中。产前检查结果表明，受影响的胎儿在妊娠晚期之前会表现出腿部运动，但在怀孕后期，即在最初的脊髓缺陷出现数月后会出现瘫痪。临床观察表明，在神经管闭合出现初始缺陷后，脊髓可能会因与羊水接触而受到持续的、渐进性的损伤。我们敦促临床医生和科学家通过研究人类产前胎儿活动以及进行实验研究来检验羊水损伤假说。如果这一假说正确，那么在主要神经损伤发生之前保护脊髓组织，或许可以预防受影响胎儿出现脊髓麻痹。如果能够改变这种疾病的发展过程，患者及其家庭将受益于致残性神经疾病痛苦的减轻，以及医疗护理的短期和长期成本的降低。
