Bronchopulmonary Dysplasia: 50 Years after the Original Description
Bronchopulmonary Dysplasia: 50 Years after the Original Description
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DOI：
10.1159/000497422
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发表时间：
2019-01-01
期刊：
影响因子：
2.5
通讯作者：
Jain, Deepak
中科院分区：
文献类型：
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作者：
Bancalari, Eduardo;Jain, Deepak
支气管肺发育不良(BPD)是新生儿医学中为数不多的疾病之一，自大约50年前首次描述以来，它一直在继续演变。多年来，新生儿医学的进步，如产前类固醇和外源性表面活性物质治疗，显著降低了新生儿死亡率，降低了早产儿的生存极限。尽管BPD的发病率仍然很高，特别是在极低出生体重的婴儿中，但临床表现已演变为死亡率较低或发病率较高的较轻微疾病。这种新的BPD是肺泡和血管发育改变、出生前和出生后致病因子的损伤以及肺内修复过程之间复杂相互作用的结果。我们在了解BPD的风险因素方面取得了重大进展，但在BPD的定义和寻找有效的预防策略方面仍然存在挑战。新的预防性干预措施，如间充质干细胞、外切体、免疫调节剂和生长因子，有很好的发展前景，但它们仍处于临床前阶段。未来的挑战包括找到根据肺病理的严重程度来定义BPD的方法，这可以更好地预测长期结果，开发肺部疾病的早期预测因子，以及找到创新的和基于证据的预防和管理策略。(C)2019年S.Karger AG，巴塞尔
Bronchopulmonary dysplasia (BPD) is one of the few diseases in neonatal medicine that has continued to evolve since its first description about 50 years ago. Over these years, advancements in neonatal medicine such as antenatal steroids and exogenous surfactant therapy have significantly reduced neonatal mortality and lowered the limits of viability for preterm infants. Although the incidence of BPD continues to be high, especially in extremely low birth weight infants, the clinical picture has evolved into a milder disease with low mortality or significant morbidities. This new BPD is the result of complex interactions between altered alveolar and vascular development, injury by ante-and postnatal pathogenic factors, and reparative processes in the lung. There has been significant progress in our understanding of risk factors for BPD, but challenges persist in its definition, and in finding effective preventive strategies. There are promising developments with newer preventive interventions such as mesenchymal stem cells, exosomes, immuno-modulators, and growth factors, but they are still in preclinical stage. The future challenges include finding ways to define BPD based on the severity of lung pathology, which can better predict long-term outcomes, development of early predictors of lung disease, and finding innovative and evidence-based preventive and management strategies. (c) 2019 S. Karger AG, Basel