Impact of preterm birth and bronchopulmonary dysplasia on the developing lung: Long-term consequences for respiratory health
Impact of preterm birth and bronchopulmonary dysplasia on the developing lung: Long-term consequences for respiratory health
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DOI：
10.1111/1440-1681.12068
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发表时间：
2013-11-01
影响因子：
2.9
通讯作者：
Harding, Richard
中科院分区：
文献类型：
--
作者：
O'Reilly, Megan;Sozo, Foula;Harding, Richard
早产影响8-10%的人类妊娠，是造成长期残疾的主要原因。早产儿，特别是患有支气管肺发育不良（BPD）的人，在婴儿期、儿童期和成年期肺功能受损的风险更高，患呼吸系统疾病的风险也更高。我们的目的是简要回顾目前对早产和BPD后肺功能和呼吸健康长期损害的基础的理解。早产儿和BPD后的婴儿和儿童的肺组织病理学显示肺实质、导气管和肺血管的发育改变。由于早产儿护理的改善，特别是外源性表面活性剂的使用和较低浓度的给氧，早产和BPD后的肺部病理不像过去那么严重。最近的研究表明，极早产和BPD可导致气道平滑肌增生、肺泡受损、肺部炎症和肺动脉肌肉化增加。成人肺的影像学显示肺泡的缺陷可以持续到以后的生活。长期肺损伤显然与婴儿期机械通气和补充氧的使用有关。晚年肺功能受损是由于气道高度反应性和肺泡减少，导致气体交换表面积减少和细支气管的物理支持。由于早产的发生率没有下降，它将继续成为成年人呼吸系统疾病的主要原因。
Preterm birth affects 8-10% of human pregnancies and is a major cause of long-term disability. Individuals who are born very preterm, especially if they develop bronchopulmonary dysplasia (BPD), have an increased risk of impaired lung function in infancy, childhood and adulthood, as well as an increased risk of respiratory illness. Our aim is to briefly review current understanding of the basis for long-term impairments in lung function and respiratory health following preterm birth and BPD. Histopathology of the lungs of infants and children following preterm birth and BPD shows altered development of the lung parenchyma, conducting airways and pulmonary vasculature. Owing to improvements in the care of preterm infants, especially the use of exogenous surfactant and lower concentrations of administered oxygen, lung pathology following preterm birth and BPD is less severe than in the past. Recent studies indicate that very preterm birth and BPD can lead to hyperplasia of airway smooth muscle, impaired alveolarization, pulmonary inflammation and an increase in pulmonary artery muscularization. Imaging of adult lungs suggests that the deficit in alveoli can persist into later life. Long-term lung injury apparently relates to the use of mechanical ventilation and the use of supplemental oxygen in infancy. Impaired lung function in later life is due to airway hyper-reactivity and fewer alveoli, resulting in reductions in the surface area for gas exchange and physical support for bronchioles. Because the incidence of preterm birth is not declining, it will continue to be a major cause of respiratory ill-health in adults.