间充质干细胞移植治疗新生儿支气管肺发育不良:机遇与挑战

支气管肺发育不良（BPD）是新生儿尤其是早产儿最常见的慢性肺部疾病，是导致早产儿预后不良的重要原因，目前临床使用的治疗手段仍然难以很好改善其预后。近年来，实验及临床研究发现间充质干细胞移植对BPD有一定疗效，可能成为未来最有希望的治疗手段。该文就间充质干细胞的特点、间充质干细胞移植治疗BPD的可能机制及临床试验的安全性和可行性，以及进一步相关临床研究面临的挑战进行阐述。     

间充质干细胞治疗支气管肺发育不良的研究进展

支气管肺发育不良( bronchopulmonary dysplasia,BPD)常见于早产儿。20世纪80年代以来随着医疗技术的提高,早产儿成活率逐渐升高,同时BPD发病率也逐渐增加。目前,BPD的常规治疗并不理想,故亟需寻求一种新创性疗法减轻BPD造成的呼吸系统损伤,提高生活质量。近年来,间充质干细胞( mesenchymal stem cell,MSC)的研究为BPD的治疗提供了新切入点。该文就MSC治疗BPD的可能作用机制及目前研究现状进行了初步探讨。     

肥大细胞在高氧肺损伤中的促纤维化作用

支气管肺发育不良(bronchopulmonary dysplasia,BPD)是一种慢性肺部疾病,通常发生于需要机械通气的早产儿,病死率高,目前缺乏有效的防治方法。经典型BPD的主要病理特征为严重的气道损伤、肺实质炎症、鳞状上皮化生及肺纤维化,虽然其发病机制尚未完全明确,但在早产儿纤维化肺中可观察到大量肥大细胞聚集,研究认为高氧刺激下肥大细胞脱颗粒释放的一系列炎症介质对BPD有重要影响。该文旨在综述肥大细胞在BPD中的促纤维化作用及机制,以期为BPD的治疗提供新的思路。     

呼吸道菌群对早产儿支气管肺发育不良相关影响的研究进展

支气管肺发育不良(bronchopulmonary dysplasia,BPD)是早产儿常见的慢性肺部疾病,严重影响早产儿生存率,其病因及发病机制复杂,且不明确。因此,BPD的预防、诊断和治疗已成为新生儿临床的重要课题。随着高通量测序技术的高速发展,人们发现呼吸道菌群可作为BPD风险的早期生物标志物发挥作用,进而评判BPD的病情进展及治疗时机,达到早期治疗并改善预后的目的。该文就早产儿BPD呼吸道菌群多样性和丰度的改变、菌群对BPD的作用机制以及未来基于菌群的治疗方法进行综述。     

支气管肺发育不良的研究进展

支气管肺发育不良(BPD)是早产儿最常见的严重呼吸系统疾病。随着产前糖皮质激素的应用、呼吸支持的改善、肺表面活性物质(PS)的应用,经典型BPD发病率有所降低,新型BPD发生率有所增多,其发病机制主要是在基因易感性的基础上,宫内和出生后的多重打击引起促炎、抗炎因子的级联反应,对发育不成熟的肺引起损伤,以及损伤后血管化失调和肺组织异常修复。在治疗上无满意的治疗策略,目前常采用的方法包括保持适当的血氧含量,允许性高碳酸血症,早期使用无创呼吸支持,使用气管内插管-PS使用-尽早拔管改用无创呼吸支持模式,常用药物为咖啡因、类固醇、外源性PS等,但具体效果仍存在争议。     

促红细胞生成素与支气管肺发育不良

支气管肺发育不良(BPD)是采用机械通气或氧气治疗早产儿急性呼吸衰竭后并发的慢性肺疾病。病因包括肺不成熟、氧中毒、感染、气压伤及容量伤等。主要病理特征为肺泡结构简化和血管生长异常。促红细胞生成素(EPO)具有抗氧化、抗感染、抗凋亡及促进血管生成等多种功能,对高氧肺损伤有一定保护作用,深入研究EPO在高氧肺损伤中的保护作用,不仅可进一步完善BPD的发病机制,也为早产儿BPD的治疗提供了新的思路。     

早产儿支气管肺发育不良相关肺外并发症研究进展

早产儿支气管肺发育不良(bronchopulmonary dysplasia, BPD)是在肺发育不成熟的基础上, 由多种因素共同作用导致肺泡化障碍而形成的一种慢性肺部疾病, 往往需要长期的氧疗或反复机械通气治疗。BPD患儿受多种因素影响, 除肺部病变外易合并肺外并发症, 如脑白质损伤、胆汁淤积症和代谢性骨病等。因此, 明确早产儿BPD与其相关并发症的关系, 了解导致肺外并发症发生的高危因素, 对改善BPD患儿的远期预后有重要意义。     

吸入和微吸入——早产儿支气管肺发育不良防治中不可忽略的问题

胃食管反流(GER)是早产儿常见的临床表现,反流引起的吸入和微吸入,通过引发气道与喉痉挛、气道阻塞、肺部炎症等多种方式,诱发或加重早产儿支气管肺发育不良(BPD)的肺部损伤。故临床治疗上应尽量避免吸入与微吸入,必要时可采取适当干预措施,对防治BPD有一定的作用。     

早产儿支气管肺发育不良的表型演变

支气管肺发育不良(bronchopulmonary dysplasia,BPD)是早产儿最常见的慢性肺部疾病,与婴儿死亡率、呼吸系统发病率增加有关。随着新生儿重症医学取得进展的同时,BPD的表型已从主要影响晚期早产儿、肺纤维囊性变演变为主要影响胎龄小于28周的超早产儿、肺实质受损和血管生长失调。文章评估了BPD定义演变、病理生理演变、影像演变及临床表型的演变特点,以期寻找新的循证预防和管理策略,改善疾病表型分类,早期识别高危早产儿的临床特点,以改善其预后。     

支气管肺发育不良与儿童哮喘关系研究进展

正支气管肺发育不良(bronchopulmonary dyspla-sia,BPD)是早产儿最常见的并发症,多年来其发病率并未有明显下降,发病机制还未完全明确。由于BPD和哮喘有部分相似的症状,国内外学者开始对二者之间的关系进行研究。本文拟对国内外BPD和儿童哮喘关系的研究进展进行阐述,旨在探究二者之间的联系和不同点,为临床预防以及治疗BPD和哮喘提供参考。     

Chronic lung disease in newborns

Chronic lung disease (CLD) or bronchopulmonary dysplasia (BPD) occurs in preterm infants who require respiratory support in the first few days of birth. Apart from prematurity, oxygen therapy and assisted ventilation, factors like intrauterine/postnatal infections, patent ductus arteriosus, and genetic polymorphisms also contribute to its pathogenesis. The severe form of BPD with extensive inflammatory changes is rarely seen nowadays; instead, a milder form characterized by decreased alveolar septation due to arrest in lung development is more common. A multitude of strategies, mainly pharmacological and ventilatory, have been employed for prevention and treatment of BPD. Unfortunately, most of them have not been proved to be beneficial. A comprehensive protocol for management of BPD based on the current evidence is discussed here.     

Bronchopulmonale Dysplasie (BPD)

Old vs. new BPD

Bronchopulmonary dysplasia (BPD) was described about 50 years ago as a fibroproliferative chronic lung disease in consequence of mechanical ventilation/oxygen exposure in premature infants with respiratory distress syndrome (old BPD). Surfactant therapy with increased survival of extremely premature infants identified a new type of an immaturity-related multisystem disorder that is characterized by a stop/simplification of alveolarisation and lung capillary development (new BPD).

Therapy

To date, mainly symptomatic treatment exists. However, growth factors and stem cell therapy have recently been tested with some success in animal experiments.

Outcome

Survivors of new BPD may have problems in adult life concerning lung and cardiovascular function, growth and neurosensory and/or motor development.     

Review shows that using surfactant a number of times or as a vehicle for budesonide may reduce the risk of bronchopulmonary dysplasia

Aim

Bronchopulmonary dysplasia (BPD) remains the most common respiratory morbidity in immature infants. This review describes the diagnosis of BPD has evolved and summarises the therapeutic approaches that have made it possible to limit the incidence of BPD.

Method

We reviewed the literature from the first definition of BPD by Northway in 1967 to the surfactant treatment policies that are currently in use, drawing on more than 50 papers up to 2017.

Results

Our review showed that improvements in neonatal survival have been associated with an increased risk of severe BPD, significant levels of long‐term morbidity and the increased use of healthcare resources. These issues have encouraged researchers to explore potential new treatments that limit the incidence of BPD. Repeated surfactant instillation and the use of surfactant as a vehicle for budesonide are promising strategies for alleviating the burden of chronic lung disease. Ongoing research on surfactant or stem cell therapy may further improve the respiratory prognosis for prematurely born children.

Conclusion

Considerable research has been carried out into the increase in BPD, which has resulted from improvements in neonatal survival. Key areas of research include repeated surfactant administration, using surfactant as a vehicle for budesonide and stem cell therapy.     

早产儿支气管肺发育不良营养管理专家共识

早产儿出生早期营养供给不足是支气管肺发育不良（BPD）发生的重要影响因素,并与其发生发展和最终临床结局密切相关。优化营养支持对降低BPD发生率和严重程度,促进患儿肺发育和神经系统预后至关重要。现基于国内外相关研究,采用证据推荐分级的评价方法（GRADE）,制定BPD营养管理专家共识,从营养在BPD中的重要性、液体量、能量、肠内营养、肠外营养、出院后营养、营养监测和评估等7个方面进行阐述,旨在为临床医师提供BPD高危儿和确诊患儿的营养管理建议,以期减少BPD的发生及改善BPD患儿的近远期预后。     

支气管肺发育不良的预防策略

<正>随着近代新生儿学的持续发展和极早早产儿存活率的不断改善,支气管肺发育不良(bronchopulmonary dysplasia,BPD)的定义发生了重大变化。BPD已不再是半个世纪前Nothway等学者提出的因高浓度氧及高压力通气导致的严重呼吸衰竭。新BPD更多发生在极早早产儿中,以损伤发育中的肺及肺血管而产生程度较轻却持续的呼吸问题为表现。由于影响肺及肺血管发育的因素贯穿早产儿产前生后的整个过程,因此对新BPD有效的预防策略应当包含多个角度,共同促进早产儿肺及肺血管的正常发育。近年来,BPD的预防在很多方面都取得了一定的进展,本文在此对部分策略做简单介绍。     

早产儿支气管肺发育不良出院后随访管理专家共识北大核心CSCD

支气管肺发育不良(bronchopulmonary dysplasia,BPD)是早产儿常见的慢性肺部疾病,严重影响其生存质量。BPD不仅威胁早产儿生命,还可能留有严重后遗症,比如喂养困难、反复下呼吸道感染、气道高反应性疾病、生长发育迟缓及神经发育迟缓等。为了进一步规范BPD早产儿出院后的随访管理,海峡两岸医药卫生交流协会新生儿学专业委员会新生儿循证医学学组基于国内外临床证据,结合临床实践经验,主要从BPD早产儿出院后呼吸系统疾病、生长发育、肺动脉高压、神经发育不良、代谢性骨病及疫苗接种的随访与管理等方面制定了该专家共识。     

Update on the diagnosis and management of bronchopulmonary dysplasia/chronic lung disease of infancy: what the radiologist should know

Pediatric radiologists are frequently called upon to render interpretations of chest radiographs performed on premature infants with chronic respiratory problems. After the acute phase of surfactant deficiency (respiratory distress syndrome), infants with persistent respiratory problems are loosely categorized by clinicians as evolving toward a broad, rather vague entity called bronchopulmonary dysplasia (BPD) or chronic lung disease (CLD). This review aims to update the radiologist on how the characteristics of the disease have shifted and how management, diagnosis and pathology have changed since the disorder was first described more than 40 years ago. The radiologist armed with this information might be better prepared to provide insightful reporting and address the needs of the neonatologist.     

支气管肺发育不良防治新进展

支气管肺发育不良（bronchopulmonary dysplasia,BPD）是极不成熟早产儿呼吸系统常见疾病.目前尚缺乏特效的治疗药物和手段,因此,预防BPD的发生、发展远比治疗重要.本文针对导致BPD发病的中心环节,系统介绍了预防早产,防治机械通气、氧化应激和感染或炎性导致的肺损伤等方面的进展.