胎盘评估早产儿脑损伤不良结局的研究进展

随着产科及新生儿重症监护技术的迅猛发展,具有极限生存活力的早产儿存活率逐年提高。但因神经系统发育不成熟,易受到各种高危因素的影响,致使脑损伤的发病率逐年上升,严重威胁早产儿的生长发育及身心健康。胎盘作为母体与胎儿连接的纽带,近年来已成为研究早产儿神经系统发育不良结局的重要器官。目前研究发现,与早产儿脑损伤有关的胎盘组织病理常伴有急性绒毛膜羊膜炎、胎盘灌注不良、绒毛膜血管病等改变;分子病理可表现为炎症因子释放增加、缺氧诱导因子过度表达与胎盘外泌体保护作用下调等变化;胎盘微小RNA(miRNAs)则可以随着宫内环境的变化而变化,反映出表观遗传调控在保护胎儿神经系统不受外来因素影响中的作用。本文从组织病理学、分子病理学及表观遗传学等方面综述早产儿胎盘的变化特点,及对神经系统发育影响的机制,以及检测早产儿胎盘对评估脑损伤不良结局的意义。

Application of Preterm Placenta in Evaluating the Adverse Outcomes of Brain Injury: A Mini Review

With the rapid development of obstetrics and neonatal intensive care technology, the survival rate of preterm infants with extreme survival has increased year by year. However, due to immature development of the nervous system, those infants are easily affected by various high-risk factors, which result in the increased incidence of brain damages. The multiple brain damages will seriously threaten the growth and development of premature infants and their physical and mental health. As the bond between mother and fetus, placenta has become an important organ in the study of neurodevelopmental dysplasia in preterm infants. It has been found that the placental histopathology associated with brain injury in preterm infants is often accompanied by the changes in acute chorionic amnionitis, placental perfusion disorder, chorionic angiopathy, et al. Molecular pathology showed the increased inflammatory factors, the excessive expressions of hypoxic induction factors and the decreased placental exosome protection. The miRNAs can be changed with the intrauterine environment, reflecting the role of epigenetic regulation in protecting the fetal nervous system from external factors. The article reviews the characteristics of placenta changes in preterm infants, including the changes of histopathology, molecular pathology and epigenetics, and the potential mechanism. It is of worth to test those placenta factors in preterm infants to assess the adverse outcomes of brain injury.