An adverse intrauterine environment: implications for injury and altered development of the brain
An adverse intrauterine environment: implications for injury and altered development of the brain
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DOI：
10.1016/j.ijdevneu.2007.08.020
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发表时间：
2008-02-01
影响因子：
1.8
通讯作者：
Walker, David
中科院分区：
文献类型：
--
作者：
Rees, Sandra;Harding, Richard;Walker, David
现在认为，胎儿期大脑的异常发育是许多贯穿一生表现出的功能和行为障碍的病因。许多因素可能是这种异常发育的基础，包括基因构成和不良的子宫内环境。这篇综述将聚焦于产前缺氧缺血性损伤以及炎症/感染性损伤。一系列实验模型已被用于描述针对这些损伤所形成的病变，并确定此类事件导致损伤的机制。相对较短时间的胎儿缺氧会导致神经元死亡（小脑、海马体和大脑皮层）、白质损伤以及神经突生长减少。这些影响在妊娠中期比晚期更为显著。慢性轻度胎盘功能不全可导致胎儿生长受限以及神经连接和髓鞘形成缺陷。早产胎儿暴露于炎症因子会导致大脑损伤，尤其是白质损伤，并且缺氧会加剧这种损伤。这些研究表明，特定损伤的时间、严重程度和性质对于确定损伤模式以及出生后神经功能受影响的程度至关重要。如果我们要制定合理的神经保护策略以减轻大脑发育异常以及不良的功能和行为结果的负担，明确脑损伤的原因、模式和机制是至关重要的。（C）2007国际标准连续出版物编号。由爱思唯尔有限公司出版。保留所有权利。
Abnormal development of the brain during fetal life is now thought to contribute to the aetiology of many functional and behavioural disorders that manifest throughout life. Many factors are likely to underlie such abnormal development including genetic makeup and an adverse intrauterine environment. This review will focus on prenatal hypoxic-ischemic injury and inflammatory/infective insults. A range of experimental models have been used to characterise lesions formed in response to these insults and to determine mechanisms of damage resulting from such events. Relatively brief periods of fetal hypoxia result in neuronal death (cerebellum, hippocampus, and cerebral cortex), white matter damage and reduced growth of neural processes. These effects are more profound at mid than late gestation. Chronic mild placental insufficiency can result in fetal growth restriction and deficits in neural connectivity and myelination. Exposure of the preterm fetus to inflammatory agents causes brain damage particularly in the white matter and this is exacerbated by hypoxia. These studies show that the timing, severity and nature of specific insults are critical in determining the pattern of injury and thus the extent to which neurological function will be affected postnatally. Defining the causes, patterns and mechanisms of brain injury is crucial if we are to develop rational neuroprotective strategies to reduce the burden of altered brain growth and poor functional and behavioural outcomes. (C) 2007 ISDN. Published by Elsevier Ltd. All rights reserved.