Retinopathy of prematurity
Retinopathy of prematurity
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DOI：
10.1007/s10456-007-9066-0
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发表时间：
2007-01-01
期刊：
影响因子：
9.8
通讯作者：
Smith, Lois E. H.
中科院分区：
文献类型：
--
作者：
Chen, Jing;Smith, Lois E. H.
早产儿视网膜病变（ROP）是一种常见的致盲性疾病，在发达国家的儿童，尽管目前的治疗，并在发展中国家变得越来越普遍。ROP分为两个阶段。第一阶段开始于出生后延迟的视网膜血管生长和现有血管的部分消退，随后是缺氧诱导的病理性血管生长的第二阶段。ROP的两个主要危险因素是使用氧气和妊娠期缩短。过量的氧气通过调节血管内皮生长因子（VEGF）而促成ROP。在ROP的I期中通过氧抑制VEGF抑制正常血管生长，而在ROP的11期中通过缺氧诱导的VEGF水平升高沉淀病理性血管增殖。胰岛素样生长因子1（IGF-1）是ROP中一个重要的非氧调节因子。我们已经发现，早产儿血清IGF-1水平与临床ROP的严重程度直接相关。IGF-1通过允许血管生长的最大VEGF刺激而间接地作为容许因子。尽管存在VEGF，但早产儿缺乏IGF-1可阻止ROP I期正常视网膜血管生长。随着婴儿的成熟，在ROP的第11阶段中IGF-1水平的升高允许VEGF刺激病理性新血管形成。这些发现表明，IGF-1恢复到正常水平可能有助于预防早产儿ROP。
Retinopathy of prematurity (ROP) is a common blinding disease in children in the developed world despite current treatment, and is becoming increasingly prevalent in the developing world. ROP progresses in two phases. The first phase begins with delayed retinal vascular growth after birth and partial regression of existing vessels, followed by a second phase of hypoxia-induced pathological vessel growth. Two major risk factors of ROP are the use of oxygen and a decreased gestation period. Excessive oxygen contributes to ROP through regulation of vascular endothelial growth factor (VEGF). Suppression of VEGF by oxygen in phase I of ROP inhibits normal vessel growth, whereas elevated levels of VEGF induced by hypoxia in phase 11 of ROP precipitate pathological vessel proliferation. Insulin-like growth factor 1 (IGF-1) is a critical non-oxygen-regulated factor in ROP. We have found that serum levels of IGF-1 in premature babies directly correlate with the severity of clinical ROP. IGF-1 acts indirectly as a permissive factor by allowing maximal VEGF stimulation of vessel growth. Lack of IGF-1 in preterm infants prevents normal retinal vascular growth in phase I of ROP, despite the presence of VEGF. As infants mature, rising levels of IGF-1 in phase 11 of ROP allows VEGF stimulated pathological neovascularization. These findings suggest that restoration of IGF-1 to normal levels might be useful in preventing ROP in preterm infants.