The effect of prenatal treatment with steroids and preterm delivery in a model of myelomeningocele on the rabbit foetus
The effect of prenatal treatment with steroids and preterm delivery in a model of myelomeningocele on the rabbit foetus
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产前类固醇治疗和早产对兔胎儿脊髓脊膜膨出模型的影响
DOI：
10.1007/s00383-006-1850-1
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发表时间：
2007
影响因子：
1.8
通讯作者：
V. Martínez
中科院分区：
文献类型：
--
作者：
C. Fontecha;J. Peirò;M. Aguirre;F. Soldado;P. Paz;M. Oria;N. Torán;V. Martínez
由于羊水化学接触和脑脊液持续渗漏，脊髓脊膜膨出 (MMC) 中的神经元件（脊髓和脑）损伤在妊娠期间似乎是进行性的。我们研究了早产和类固醇治疗对兔胎儿 MMC 模型的影响。 12 只新西兰白兔在妊娠 23 天时接受了剖腹手术和子宫切开术。 107 名胎儿中有 59 名接受了腰椎椎板切除术（三至四节）。打开硬脑膜，将神经元件暴露于羊水中。 6只兔子在妊娠第31天进行剖腹产以收获胎儿；其中三人未接受治疗（T 组），三人接受皮质类固醇治疗（TC 组）。另外六只兔子在妊娠第29天进行剖腹产以收获胎儿（早产）；其中三人未接受治疗（P 组），三人接受皮质类固醇治疗（PC 组）。对活着的新生儿进行临床、神经生理学和组织学分析。没有一位母亲在手术过程中死亡。出生后，早产组动物的畸形程度明显低于足月组动物。 PC 组（早产组和类固醇组）观察到后凸畸形程度较低。在接受皮质类固醇（TC 和 PC）治疗的组中，下肢的疼痛相关性和自发活动度较高。只有足月新生儿（T 组和 TC 组）表现出对诱发电位 (CMEP) 的反应。类固醇（TC）治疗组的反应更早、更高。在组织学上，我们观察到脊髓的进行性病变。使用类固醇（TC 和 PC）治疗的组显示出较少的炎症反应。所有组均存在 Arnold-Chiari 畸形。与足月组相比，使用类固醇的早产组动物的疝气明显减少，具有统计学意义。早产和产前类固醇治疗似乎是减少脊髓脊膜膨出胎儿神经损伤（脊髓和脑）的有效治疗方法。
Damage of neural elements (spinal cord and encephalus) in myelomeningocele (MMC) seems to be progressive during gestation because of amniotic fluid chemical contact and continuous leakage of CSF. We studied the effect of preterm delivery and steroid treatment in a model of MMC in the rabbit foetus. Twelve New Zealand White rabbits underwent laparotomy and hysterotomy at 23 days of gestation. Fifty-nine out of 107 foetuses underwent lumbar laminectomy (three to four levels). Dura was opened to expose the neural elements to the amniotic fluid. Six rabbits underwent caesarean section on gestational day 31 for fetal harvest; three of them had no treatment (group T) and three received corticosteroid treatment (group TC). The other six rabbits underwent caesarean section on gestational day 29 for fetal harvest (preterm delivery); three of them had no treatment (group P) and three received corticosteroid treatment (group PC). Alive newborns were clinically, neurophysiologically and histologically analysed. None of mothers died during the procedure. After birth, animals in group preterm showed statistically significant less deformity than animals in group at term. Lower kyphosis was observed in group PC (preterm and steroids). Pain related and spontaneous mobility of lower extremities was higher in groups treated with corticosteroids (TC and PC). Only newborns at term (T and TC groups) showed response to evoked potentials (CMEPs). The response was earlier and higher in group treated with steroids (TC). Histologically, we observed progressive lesion of the spinal cord. Groups treated with steroids (TC and PC) show less inflammatory response. Arnold–Chiari malformation was present in all groups. Animals in group preterm with steroids show statistically significant less herniation than those group at term. Preterm delivery and prenatal steroid therapy seem to be an effective treatment to get less neural injury (spinal cord and encephalus) in myelomeningocele foetuses.