Pathogenesis and prevention of intraventricular hemorrhage.

Pathogenesis and prevention of intraventricular hemorrhage.
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DOI:
10.1016/j.clp.2013.09.007
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发表时间:
2014-03
影响因子:
2.1
通讯作者:
Ballabh P
Ballabh P
中科院分区:
医学4区
文献类型:
--
作者:
Ballabh P

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脑室内出血(IVH)是早产的主要神经系统并发症。脑室内出血的发病机制与生发基质血管的内在脆弱性和脑血流的波动有关。生发基质表现出快速的血管生成,协调未成熟血管的形成。血管生成血管缺乏周细胞,显示未成熟的基底层纤维连接蛋白含量低,星形胶质细胞端足覆盖缺乏胶质纤维酸性蛋白。这些因素导致生发基质血管系统脆弱。脑血流量的波动是由与早产儿相关的大范围呼吸和血流动力学不稳定引起的。产前糖皮质激素暴露仍然是预防IVH的最有效手段。针对增强生发基质血管系统稳定性和最小化脑血流量波动的治疗可能导致更有效的预防IVH的策略。
Intraventricular hemorrhage (IVH) is a major neurological complication of prematurity. Pathogenesis of intraventricular hemorrhage is attributed to intrinsic fragility of germinal matrix vasculature and to the fluctuation in the cerebral blood flow. Germinal matrix exhibits rapid angiogenesis orchestrating formation of immature vessels. The angiogenic vessels lack pericytes, display immature basal lamina low in fibronectin, and have astrocyte end-feet coverage deficient in glial fibrillary acidic protein. These factors contribute to the fragility of the germinal matrix vasculature. Fluctuation in the cerebral blood flow results from a wide range of respiratory and hemodynamic instability associated with the preterm infants. Prenatal glucocorticoid exposure remains the most effective means of preventing IVH. Therapies targeted to enhance the stability of the germinal matrix vasculature and minimize fluctuation in the cerebral blood flow might lead to more effective strategies in preventing IVH.
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