Influences of developmental age on the resolution of diffuse traumatic intracranial hemorrhage and axonal injury.
Influences of developmental age on the resolution of diffuse traumatic intracranial hemorrhage and axonal injury.
复制标题
发育年龄对弥漫性创伤性颅内出血和轴突损伤消退的影响。
DOI：
10.1089/neu.2013.3113
复制
发表时间：
2014
影响因子：
4.2
通讯作者：
Margulies,SusanS
中科院分区：
文献类型：
--
作者：
Weeks,Dianne;Sullivan,Sarah;Kilbaugh,Todd;Smith,Colin;Margulies,SusanS
本研究采用猪脑损伤模型，研究了两个儿童年龄组弥漫性创伤性轴索损伤（TAI）和区域硬膜下和蛛网膜下腔颅内出血（ICH）的年龄依赖性损伤反应。55只5日龄和40只4周龄的仔猪（发育上分别与婴儿和幼儿相对应）在矢状面接受假损伤或单次快速无冲击旋转损伤，并根据tbi后生存时间（假，3-8小时，1天，3-4天和5-6天）进行分组。两个年龄组表现出相似的初始脑出血水平，随着时间的推移脑出血显著减少（p<0.0001）。然而，在5天大的年龄组中，ICH需要更长的时间来解决。损伤后5 ~ 6 d， 4周龄仔猪脑内ICH水平已恢复到假水平，而5日龄仔猪脑内ICH水平仍显著升高（p=0.012）。两个年龄的大鼠对轴突损伤的缓解程度相似，损伤后1天TAI达到峰值（p<0.03），损伤后5-6天TAI水平显著升高（p<0.008），这表明损伤后1天对第二次损伤的脆弱性窗口期可能会延长很长一段时间。然而，总体而言，5日龄仔猪的TAI明显高于4周龄仔猪（p=0.016），这为该年龄组脑损伤易感性增加提供了一些证据。这些结果为临床干预的最佳窗口，对第二次损伤的易感性增加的时期，以及儿童脑损伤耐受性的年龄依赖性提供了见解。
This study investigated the age-dependent injury response of diffuse traumatic axonal injury (TAI) and regional subdural and subarachnoid intracranial hemorrhage (ICH) in two pediatric age groups using a porcine head injury model. Fifty-five 5-day-old and 40 four-week-old piglets—which developmentally correspond to infants and toddlers, respectively—underwent either a sham injury or a single rapid non-impact rotational injury in the sagittal plane and were grouped by post-TBI survival time (sham, 3–8 h, one day, 3–4 days, and 5–6 days). Both age groups exhibited similar initial levels of ICH and a significant reduction of ICH over time (p<0.0001). However, ICH took longer to resolve in the five-day-old age group. At 5–6 days post-injury, ICH in the cerebrum had returned to sham levels in the four-week-old piglets, while the five-day-olds still had significantly elevated cerebral ICH (p=0.012). Both ages also exhibited similar resolution of axonal injury with a peak in TAI at one day post-injury (p<0.03) and significantly elevated levels even at 5–6 days after the injury (p<0.008), which suggests a window of vulnerability to a second insult at one day post-injury that may extend for a prolonged period of time. However, five-day-old piglets had significantly more TAI than four-week-olds overall (p=0.016), which presents some evidence for an increased vulnerability to brain injury in this age group. These results provide insight into an optimal window for clinical intervention, the period of increased susceptibility to a second injury, and an age dependency in brain injury tolerance within the pediatric population.