Recent Advances in Bronchopulmonary Dysplasia Protection and Therapy

For preterm infants, bronchopulmonary dysplasia (BPD) is usually caused by abnormal lung development due to various factors during prenatal and postnatal process. One of the reasons for death and bad prognosis of preterm infants is to have BPD. Up to now, there are no unified strategies or drugs to treat BPD. In clinical, many intervention treatments have been applied to achieve BPD therapy, mainly including preterm protection, protective ventilation strategies, and delivery of corticosteroids, pulmonary vasodilators, and antioxidants. This review summarizes the current advances in BPD protection and treatment, and notes that gut microbiota and mesenchymal stem cells (MSCs) can be the promising strategy for protecting and treating BPD in the future.

Influence of Gut and Lung Microbiota and the Gut-Lung Axis on Bronchopulmonary Dysplasia

Bronchopulmonary dysplasia(BPD),also known as neonatal chronic lung disease,is a common respiratory disease in preterm infants.Preterm infants with BPD often exhibit changes in gut and lung microbiota.In recent years,with the development of high-throughput sequencing technology,more and more mechanisms of the gut-lung axis have been confirmed,helping to explore new directions for the treatment of BPD using microecological agents.This paper reviews the roles of gut microbiota,lung microbiota,and the gut-lung axis in the pathogenesis of BPD in preterm infants,providing new research avenues for the prevention and treatment of BPD.

Early Intratracheal Administration of Corticosteroid and Pulmonary Surfactant for Preventing Bronchopulmonary Dysplasia in Preterm Infants with Neonatal Respiratory Distress Syndrome: A Meta-analysis

There is uncertain result with regard to the use of inhalation or instillation steroids to prevent bronchopulmonary dysplasia in preterm infants. This meta-analysis was designed to evaluate the efficacy and safety of early airway administration (within 2 days after birth) of corticosteroids and pulmonary surfactant (PS) for preventing bronchopulmonary dysplasia (BPD) in premature infants with neonatal respiratory distress syndrome (NRDS). The related studies were retrieved in PubMed, EMBASE, the Cochrane Library, Clinical Trial, CNKI, Wanfang and VIP Database from inception to August 2018. Two reviewers independently screened the studies to ensure that all patients with diagnosis of NRDS were enrolled to studies within 1 day after birth, assessed the quality of included studies by GRADEpro system and extracted the data for review. The meta-analysis was performed by RevMan 5.2 software. A subgroup analysis about inhaled corticosteroid (ICS) delivery method was made between ICS inhalation subgroup [inhalation of ICS by nebulizer or metered dose inhaler (MDI)] and ICS intratracheal instillation subgroup (PS used as a vehicle). Eight randomized controlled trials were enrolled in the meta-analysis, 5 trials of which stated the randomized method, grouping and blinded method, and the follow-up procedures were reported. GRADEpro system showed high quality of 4 trials (5 articles), and the rest 4 trials had moderate quality. Meta-analysis showed that the incidence of BPD was decreased in ICS group, the relative risk (RR) was 0.56 (95% CI: 0.42-0.76), and similar trends were found in ICS inhalation subgroup and ICS intratracheal instillation subgroup, with the corresponding RR being 0.58 (95% CI: 0.41-0.82) and 0.47 (95% CI: 0.24-0.95) respectively. ICS could also significantly reduce the mortality risk as compared with placebo control group (RR: 0.67;95% CI: 0.45-0.99), with RR of ICS inhalation subgroup and ICS intratracheal instillation subgroup being 0.81 (95% CI: 0.34-1.94) and 0.64 (95% CI: 0.41-0.99) respectively. Moreover, the percentage of infants using PS more than one time was lower in ICS group than in the placebo control group, with the RR and 95% CI being 0.55 (95% CI: 0.45-0.67), and that in ICS intratracheal instillation subgroup lower than in ICS inhalation subgroup (RR: 0.56;95% CI: 0.45-0.69, and RR: 0.35;95% CI:0.08-1.52 respectively). There was no significant difference in the incidence of infection or retinopathy of prematurity and neuro-motor system impairment between ICS group and placebo control group, with the corresponding RR being 0.95 (95% CI:0.59-1.52), 0.92 (95% CI: 0.62-1.38) and 1.13 (95% CI: 0.92-1.39), respectively. It was concluded that early administration of ICS and PS is an effective and safe option for preterm infants with NRDS in preventing BPD and reducing mortality, decreasing the additional PS usage, especially for the ICS intratracheal instillation subgroup. Furthermore, the appropriate dose and duration of ICS, combined use of inhalation or instillation of ICS with PS and the long-term safety of airway administration of corticosteroids need to be assessed in large trials.

Association of Ureaplasma urealyticum Colonization with Development of Bronchopulmonary Dysplasia: A Systemic Review and Meta-analysis

There is controversy regarding the roles of Ureaplasma urealyticum （U. urealyticum） colo- nization in the development of hronchopulmonary dysplasia （BPD）. This study explored the association between U. urealyticum and bronchopulmonary dysplasia at 36 weeks post-menstrual age （BPD36）. Studies published before December 31, 2013 were searched from Medline, Embase, Ovid, Web of Sci- ence, and Cochrane databases, with the terms ＂Ureaplasma urealyticum＂, ＂chronic lung disease＂, or ＂BPD36＂ used, and English language as a limit. The association between U. urealyticum colonization and BPD36 was analyzed with RevMan 4.2.10 software, using the odds ratio （OR） and relative risk （RR） for dichotomous variables. Out of the enrolled 81 studies, 11 investigated the BPD36 in total 1193 in- fants. Pooled studies showed no association between U. urealyticum colonization and subsequent de- velopment of BPD36, with the OR and RR being 1.03 （95% CI=0.78-1.37; P=-0.84） and 1.01 （95% CI= 0.88-1.16, P=-0.84）, respectively. These findings indicated no association between U. urealyticum colo- nization and the development of BPD36.

Association of Surfactant Protein B Gene Polymorphisms (C/A-18, C/T1580, Intron 4 and A/G9306) and Haplotypes with Bronchopulmonary Dysplasia in Chinese Han Population

Summary： This study aimed to investigate the association between surfactant protein B （SP-B） pol- ymorphisms and bronchopulmonary dysplasia （BPD） in Chinese Han infants. We performed a case- control study including 86 infants with BPD and 156 matched controls. Genotyping was performed by sequence specific primer-polymerase chain reaction （PCR） and haplotypes were reconstructed by the fastPHASE software. The results showed that significant differences were detected in the geno- type distribution of C/A-18 and intron 4 polymorphisms of SP-B gene between cases and controls. No significant differences were detected in fhe genotype distribution of C/T1580 or A/G9306 be- tween the two groups. Haplotype analysis revealed that the frequency of A-del-C-A haplotype was higher in case group （0.12 to 0.05, P=0.003）, whereas the frequency of C-inv-C-A haplotype was higher in control group （0.19 to 0.05, P=0.000）. In addition, a significant difference was observed in the frequency of C-inv-T-A haplotype between the two groups. It was concluded that the polymor- phisms of SP-B intron 4 and C/A-18 could be associated with BPD in Chinese Han infants, and the del allele of intron 4 and A allele of C/A-18 might be used as markers of susceptibility in the disease. Haplotype analysis indicated that the gene-gene interactions would play an important part in deter- mining susceptibility to BPD.

Plasma Asymmetric Dimethylarginine Levels in Neonates with Bronchopulmonary Dysplasia Associated with Pulmonary Hypertension

Background: Bronchopulmonary dysplasia (BPD) continues to be an important problem in neonates especially premature infants despite improved facilities of care, monitoring and treatment. Pulmonary hypertension (PH) is a major complicating factor and key cause of mortality in this population. Altered vascular and alveolar growth particularly in canalicular and early saccular stages of lung development following mechanical ventilation and oxygen therapy result in arrest of the lung development leading to BPD with PH. Early recognition of PH in infants with these risk factors is important for optimal management. We tested the hypothesis that asymmetric dimethylarginine, would be greater in infants with bronchopulmonary dysplasia associated pulmonary hypertension than in infants with BPD alone. The Aim: The aim of the current study was to measure the Asymmetric dimethylarginine (ADMA) levels, arginine levels & the plasma arginine-to-ADMA ratio in newborn infants with broncho-pulmonary dysplasia, to evaluate echocardiographic parameters among neonates with bronchopulmonary dysplasia, to correlate between plasma ADMA & arginine-to-ADMA ratio and echocardiographic (ECHO) parameters in those patients and to compare full term & preterm neonates with bronchopulmonary dysplasia as regard to plasma ADMA level. Methods: A case-control study was carried out of ninety (90) newborns selected from those admitted to Neonatal Intensive Care Unit at Maternity & Children Hospital and Alzhraa University hospital during the period from October 2015 to March 2018. Neonates were divided into 2 groups: Patient with BPD with PH (cases group): It included 45 neonates with BPD & PH, 35 preterm neonates and 10 full term neonates. Patient with BPD only (Control group): It included 45 neonates with BPD without PH. These 45 neonates were divided as 22 preterm neonates and 23 full term neonates. Laboratory work was done in Alzhraa University hospital. Asymmetric dimethylarginine (ADMA) levels & arginine levels were measured using competitive enzyme linked immune-assay (ELISA). Results: Patients with both BPD and PH had greater plasma levels of ADMA than patients with BPD alone (P value 0.000). ADMA level > 186 ng/dl can predict development of PH in patient with BPD with sensitivity 100% and specify 100%. Preterm neonates with BPD had greater level of ADMA than full term neonates (P value 0.002). There was no statically significance difference between level of ADMA if withdrawn before or after 28 days of age (range of age at time of sampling in our study was 23 - 40 days) (P value 0.878), even ADMA level increased above the cut point early in the disease before we screened some cases by ECHO. There was no statically significance difference between level of arginine in cases and control groups with P value 0.530. The plasma arginine-to-ADMA ratio was lower in cases than in controls suggesting a greater likelihood of inhibition of nitric oxide production in patients with both BPD and PH than in patients with BPD alone (P value 0.000). ADMA level can predict severity of pulmonary hypertension in patient with BPD, as it was positively correlated with the grade of pulmonary hypertension (P value 0.006). ADMA level is higher in neonates with BPD and PH who died than those who survived;it can predict death in neonates with BPD &PH at cut off point > 643 ng/dl. Conclusion: ADMA increased in newborn infants with BPD, who developed PH. ADMA may have diagnostic and prognostic values. ADMA level was higher in preterm neonates than full term neonates and its level was correlated positively with severity of PH. ADMA levels were significant higher in infants with BPD with PH who died later than those who survived. There was no statically significance difference between levels of ADMA, whether it was drawn before or after 28 days of age (range 23 - 40 days). Echocardiographic screening and ADMA measurement could help in prevention of PH, diagnosis and early treatment of newborn infants suffering from BPD.

吸入氢气对高氧诱导新生SD大鼠支气管肺发育不良(BPD)的影响

目的探讨吸入氢气对高氧诱导新生SD大鼠支气管肺发育不良(BPD)的影响。方法选取新生SD大鼠吸入85%高氧建立支气管肺发育不良模型。分为control组(正常空气)9只、BPD组(85%O_(2))13只、H_(2)组(2%H_(2))12只及Treat组(85%O_(2)+2%H_(2))16只,共4组。记录各组大鼠体重;14 d后取肺组织,采用苏木精-伊红(HE)染色法进行病理切片观察与评价;肺组织匀浆上清液检测肺损伤的标志物神经酰胺(Cer);取血,检测脑损伤标志物肌钙结合蛋白(S100B)、心肌损伤标志物心肌肌钙蛋白(cTnI)并进行比较。结果BPD组体重增长显著慢于control组,差异有统计学意义(F=7.122,<0.05)。HE染色结果显示高氧使肺泡简化,肺泡数量明显减少,吸入氢气可有效改善;4组肺泡平均截距比较,BPD组>Treat组肺泡>control组与H_(2)组,差异有统计学意义(F=24.951,P<0.05)。Cer水平BPD组>control组、H_(2)组与Treat组,cTnI水平BPD组>H_(2)组>Treat组>control组,S100B水平BPD组>Treat组>H_(2)组、control组,差异具有统计学意义(F=19.361、26.321、13.235,P<0.05)。结论吸入H_(2)可改善肺损伤,改善脑损伤与心肌损伤,其机制可能与抗氧化有关。

Successful treatment of pulmonary hypertension in a neonate with bronchopulmonary dysplasia: A case report and literature review

BACKGROUND Pulmonary hypertension(PH)is a severe complication of bronchopulmonary dysplasia(BPD)in premature neonates and is closely related to prognosis.However,there is no effective and safe treatment for PH due to BPD in infants.Successful treatment for cases of BPD-associated PH with Tadalafil combined with bosentan is rare.This case may make a significant contribution to the literature because PH is difficult to manage as a serious complication of BPD in preterm infants.Mortality is high,especially when it is complicated by heart failure.CASE SUMMARY An extremely premature neonate with a gestational age of 26+5 wk and birth weight of 0.83 kg was diagnosed with BPD associated with PH;oral sildenafil did not improve the PH.The infant experienced sudden cardiac arrest and serious heart failure with severe PH.After a series of treatments,including cardiopulmonary resuscitation,mechanical ventilation,and inhaled nitric oxide(iNO),the respiratory and circulatory status improved but the pulmonary artery pressure remained high.Then oral sildenafil was replaced with oral tadalafil and bosentan;pulmonary artery pressure improved,and the infant recovered at our hospital.After 2 years of follow-up,she is in good condition,without any cardiovascular complications.CONCLUSION INO can effectively improve the respiratory and circulatory status of infants with PH associated with premature BPD.B-type natriuretic peptide should be routinely measured during hospitalization to evaluate the risk and prognosis of BPD-associated PH in preterm infants.Tadalafil combined with bosentan for the treatment of PH associated with premature BPD was better than sildenafil in this case.Further studies are needed to explore the efficacy and safety of different vasodilators in the treatment of PH associated with premature BPD.

Research Progress in Bronchopulmonary Dysplasia: A Narrative Review by Etiology

Background: Bronchopulmonary Dysplasia (BPD) is a chronic lung condition that primarily affects preterm infants. Genetic predispositions, environmental factors, prenatal, and postnatal risk factors have been associated with bronchopulmonary dysplasia. However, there is a lack of consensus regarding these factors. Purpose: To examine the available information on pathogenesis and summarize the points of agreement to generate concise information that can guide patient management and spur further research. Method: PubMed, Embase and Web of Science were used to search for studies that analyzed the risk factors associated with bronchopulmonary dysplasia between 2006 and 2022 with the key search terms “bronchopulmonary dysplasia, etiology, preterm birth, mechanical ventilation”. Results: This study found that the pathogenesis of bronchopulmonary dysplasia is multifactorial, involving close interactions among these major etiological factors and other minor risk factors. A combination of mechanical ventilation, intrauterine factors, inflammation, genetic predispositions, insufficient surfactants, docosahexaenoic acid, and nutrition, among other minor risk factors, was all required in one way or another to influence BPD development. Therefore, studies should continuously update and incorporate the emerging information to assist frontline healthcare workers and generate qualitative data for clinical trial design and further research. Conclusion: Bronchopulmonary Dysplasia is different from other respiratory illnesses, and the pathogenesis of bronchopulmonary is multifactorial.

Bronchopulmonary Dysplasia in Premature Infants with Very Low Birth Weight: A Single Centre Retrospective Study in China

To investigate bronchopulmonary dysplasia (BPD) and its treatment with dexamethasone (DEX) in premature infants with birth weight (BW) < 1500 g. We retrospectively reviewed the records of preterm infants admitted to the Division of Neonatology, the Second Xiangya Hospital, Central South University between September 2011 and December 2014. Patients were excluded if they needed oxygen therapy but were lost to follow-up at ≤36 weeks post-menstrual age (PMA) or <56 days after birth, or they had severe congenital anomalies. The incidence of BPD was 18% (37/212). Gestational age (GA) was <32 weeks in all BPD patients. GA, BW, and Apgar scores were lower and hospitalization duration and pulmonary surfactant (PS) use were higher in the BPD group than in the non-BPD group (P < 0.05). Risk factors for BPD included neonatal respiratory distress syndrome, neonatal pneumonia, positive sputum culture, pulmonary hemorrhage, respiratory failure. Multivariate logistic regression revealed that GA (odds ratio [OR]: 0.479, P = 0.004) and neonatal respiratory distress syndrome (OR: 6.146, P = 0.043) were independent risk factors for BPD. DEX was administered to 26 patients after the diagnosis of BPD. After one and two weeks of DEX treatment, the oxygen requirement had significantly reduced compared to the week prior to treatment (P < 0.05), while during treatment, the weight gain rate and weight gain efficiency slower significantly than that during either of the two preceding weeks (P < 0.001). These results suggest that low GA was the most important risk factor for BPD, DEX reduced oxygen dependency but decreased weight gain.

自噬对BPD大鼠NLRP3炎症小体的调控作用

目的:探讨在高氧诱导的新生大鼠支气管肺发育不良(BPD)中自噬和核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)炎症小体之间的关系及其对肺发育结局的影响。方法:用85%O 2制造BPD新生大鼠模型,与常氧(21%O 2)新生大鼠对比,选择生后第3、7、14天的新生大鼠肺组织做病理切片,使用苏木精-伊红染色观察肺组织形态变化(RAC、MLI),Western blot测肺组织LC3、P62蛋白,确定自噬流变化。雷帕霉素组新生大鼠与高氧组在同一高氧环境中,于生后第2、4、6天予以腹腔注射雷帕霉素。高氧组与常氧组注射同等量生理盐水。选择生后第7天,Western blot测肺组织MTOR、LC3、P62、NLRP3、ASC、cleaved-caspase-1、cleaved-IL-1β,PCR测LC3、NLRP3、cleaved-caspase-1的mRNA,确定其自噬与炎症小体活性之间的关系。结果:肺组织HE染色示生后第7、14天RAC(P<0.05)常氧组均高于高氧组;MLI(P<0.05)高氧组均高于常氧组。Western blot示生后第3、7天LC3-Ⅱ/LC3-Ⅰ(P<0.01),P62(P<0.05)高氧组均高于常氧组。生后第7天肺组织HE染色示高氧组RAC低于常氧组和雷帕霉素组(P<0.05),MLI高于常氧组和雷帕霉素组(P<0.05),生后第7天Western blot示高氧组的MTOR、LC3-Ⅱ/LC3-Ⅰ、P62、NLRP3、ASC、cleaved-caspase-1、cleaved-IL-1β均高于正常组和雷帕霉素组(P<0.05)。qPCR示高氧组的LC3mRNA低于正常组和雷帕霉素组(P<0.05),而NLRP3、caspase-1的mRNA均高于正常组和雷帕霉素组(P<0.05)。结论:自噬流与炎症小体之间的相互作用是BPD发生发展的重要因素,通过增加自噬流可以减少炎症小体的活性,减少cleaved-IL-1β的生成,进而改善BPD,为进一步治疗BPD提供依据。

重组促红细胞生成素联合布地奈德对早产儿BPD动脉血气指标、炎性反应的影响

目的研究重组促红细胞生成素结合布地奈德对早产儿支气管肺发育不良(BPD)动脉血气指标、炎性反应、呼吸机应用及吸氧时间的影响。方法选取2021年11月至2022年10月治疗的116例早产儿,根据信封法把患儿分为观察组与对照组,对照组57例给予布地奈德进行治疗,观察组59例给予重组促红细胞生成素联合布地奈德进行治疗。比较2组患儿动脉血气指标、白细胞介素-8(IL-8)、肿瘤坏死因子(TNF-α)等炎性因子以及撤机时间、有创通气时间、住院时间、总吸氧时间,统计并发症发生情况。结果治疗前2组氧分压(PO_(2))、二氧化碳分压(PCO_(2))、IL-8、TNF-α、IL-4水平、治疗后颅内出血、早产儿视网膜病、感染比例比较,差异无统计学意义(P>0.05);2组治疗后PO_(2)高于治疗前且观察组患儿更高(P<0.05),治疗后2组患儿TNF-α、PCO_(2)、IL-8以及IL-4较治疗前下降且观察组更低(P<0.05);观察组患儿总吸氧时间、有创通气时间、住院时间及撤机时间较比照组短(P<0.05);治疗后观察组患儿早产儿贫血及BPD发生比例较对照组低(P<0.05)。结论重组促红细胞生成素联合布地奈德可显著改善早产儿氧合,降低炎性反应,明显缩短吸氧时间及呼吸机使用时间,降低早产儿BPD发生率。

早产儿BPD的危险因素及血浆BMP-7 miR-15b 25-(OH)D_(3)对其诊断价值分析

目的 探讨早产儿支气管肺发育不良(BPD)的危险因素及血浆骨形成蛋白-7(BMP-7)、微小核糖核酸-15b(miR-15b)、25羟基维生素D_(3)[25-(OH)D_(3)]对其诊断价值。方法 回顾性分析2022年1月至2023年3月河北省沧州中西医结合医院收治的136例早产儿的临床资料,根据其是否伴有BPD,将其分为BPD组(n=45)和非BPD组(n=91)。分析早产儿BPD的单因素,采用多因素logistic回归分析早产儿BPD的危险因素,绘制受试者工作特征(ROC)曲线分析血浆BMP-7、miR-15b、25-(OH)D_(3)对早产儿BPD的诊断价值。结果 两组患儿机械通气时间、吸氧时间、有无脓毒血症及血浆BMP-7、miR-15b、25-(OH)D_(3)水平比较,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,机械通气时间长、血浆BMP-7、miR-15b水平偏高、血浆25-(OH)D_(3)水平偏低是早产儿BPD的独立危险因素(OR=2.625、2.208、2.280、2.517,P<0.05)。血浆BMP-7、miR-15b、25-(OH)D_(3)联合诊断早产儿BPD的曲线下面积为0.947,高于血浆BMP-7、miR-15b、25-(OH)D_(3)单独检测(0.822、0.849、0.824,P<0.05)。结论 早产儿BPD的危险因素与机械通气时间长、血浆BMP-7、miR-15b水平偏高、血浆25-(OH)D_(3)水平偏低有关,且血浆BMP-7、miR-15b、25-(OH)D_(3)联合检测对早产儿BPD的诊断价值更高。

改良肺超声评分对支气管肺发育不良新生儿预后的预测效能

目的:探讨改良肺超声评分(mLUS)对支气管肺发育不良(BPD)新生儿预后的预测效能。方法:纳入122例胎龄<34周的早产儿作为研究对象,根据有无BPD,分为无BPD组28例和BPD组94例;并根据BPD严重程度将BPD组分为轻度组30例、中度组33例及重度组31例。采用Pearson相关系数分析mLUS与患儿短期临床预后的相关性,ROC曲线分析mLUS对短期临床预后的预测效能。结果:无BPD组及BPD轻度组、中度组、重度组的孕龄、出生体质量、Apgar评分、出生后全身类固醇治疗、校正胎龄40周时呼吸支持情况及出院时的氧气需求比较,差异均有统计学意义(均P<0.05)。Pearson相关系数分析显示:mLUS与BPD严重程度、全身类固醇治疗、校正胎龄40周时呼吸支持情况及出院时的氧气需求均呈正相关(r=0.835,0.714,0.581,0.779;均P<0.05);LUS与BPD严重程度、全身类固醇治疗及校正胎龄40周时呼吸支持情况均呈正相关(r=0.766,0.637,0.571;均P<0.05),与出院时的氧气需求无相关性(r=0.601,P=0.153)。ROC曲线分析显示,mLUS预测BPD严重程度的AUC为0.944(95%CI0.877~0.981),LUS的AUC为0.852(95%CI0.764~0.917)。DeLong检验显示,mLUS与LUS的AUC差异有统计学意义(Z=2.222,P=0.026)。结论:mLUS与BPD严重程度及其他短期临床结果显著相关,且能较好地预测新生儿的预后。

支气管肺发育不良的预后

支气管肺发育不良(bronchopulmonary dysplasia,BPD)患儿在学龄期及成年时常呈现严重的呼吸系统问题,肺功能受损严重。运动测试显示BPD儿童心肺功能和运动能力下降,合并肺动脉高压发生率高,在智力、语言和运动发展方面普遍较差。随着年龄增长,神经发育障碍的风险增加,健康相关生活质量也受到影响。该文对BPD患儿呼吸系统、运动能力、心血管系统、神经系统及健康相关生活质量方面的预后进行综述,旨在更好地管理BPD患儿,提高其后续的生活质量。

超短回波时间序列在肺功能成像的应用进展

近几年来,超短回波时间(ultrashort echo time,UTE)序列弥补了先前的空白,在肺实质结构的评估方面逐步应用,适于新生儿和儿童肺部疾病形态学变化的纵向随访。但MRI的突出优势之一是功能成像,通过将UTE序列与肺功能MRI(包括超极化气体、灌注和氧增强造影)相结合,进行定量功能测定,利用固有配准图像显示支气管扩张、粘液堵塞、肺纤维化和空气潴留后的肺部功能,对改善限制性和阻塞性肺部疾病的诊断和预后具有潜在价值。本文综述了UTE序列肺部结构及功能成像的研究进展,揭示了该序列的技术原理和应用优势,旨在为未来进一步探索UTE序列在肺部疾病的应用提供参考。

早产儿高氧导致脑损伤的研究进展

新生儿重症监护室(NICU)技术的发展,使得氧疗普遍应用于早产儿抢救治疗中,提高了早产儿存活率。然而,与高氧相关的早产儿脑病(EOP)、早产儿视网膜病(ROP)和支气管肺发育不良(BPD)等并发症严重影响存活早产儿的生存质量。本文综述了高氧导致脑损伤的临床及动物实验研究现状,明确与高氧相关早产儿神经系统损伤可能的表现及机制,为早产儿临床安全用氧决策提供理论依据。

袋鼠式护理干预在新生儿重症监护室支气管肺发育不良早产儿中的应用效果观察

目的探讨袋鼠式护理干预在新生儿重症监护环境下对支气管肺发育不良早产儿治疗效果的研究。方法选取86例河南省人民医院新生儿重症监护室收治的患有支气管肺发育不良的早产儿进行研究,其就诊时间均在2022年5月至2024年2月。采取随机数字表法将所有患儿进行分组,43例对照组患儿采用常规护理干预;43例观察组患儿在常规护理的基础上采用袋鼠式护理干预。观察两组患儿生长发育情况、血气分析指标、住院时间及并发症发生率。结果护理前,两组患儿生长发育情况比较,差异无统计学意义(P>0.05);出生30天后,两组患儿生长发育各项指标较护理前均有改善,且观察组护理后体重高于对照组、头围及身长大于对照组,差异有统计学意义(P<0.05)。护理前,两组患儿血气分析指标比较,差异无统计学意义(P>0.05);出生30天后,两组患儿血气分析指标较护理前均有改善,且观察组患儿动脉血氧分压高于对照组、动脉血氧饱和度高于对照组、动脉血二氧化碳分压低于对照组,差异有统计学意义(P<0.05)。观察组患儿住院时间短于对照组,差异有统计学意义(P<0.05)。观察组患儿并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论对新生儿重症监护室中患有支气管肺发育不良的早产儿实施袋鼠式护理临床效果显著。该护理方式不仅能够有效促进早产儿生长和发育,还能改善其血气分析结果,缩短住院周期,并减少并发症发生率。

超早产儿/超低出生体重儿支气管肺发育不良危险因素分析

目的探究超早产儿/超低出生体重儿支气管肺发育不良(bronchopulmonary dysplasia,BPD)的危险因素,并构建logistic回归预测模型。方法选取2017年1月1日至2023年12月31日周口市妇幼保健院及周口市中医院新生儿重症监护室住院治疗的超早产儿/超低出生体重儿病历资料,严格按照纳入和排除标准,共纳入102例,根据是否发生BPD分为BPD组和非BPD组,比较两组一般资料,采用logistic回归分析导致超早产儿/超低出生体重儿发生BPD的病理原因。结果本研究共纳入102例超早产儿/超低出生体重儿,其中59例出现BPD,发生率为57.8%;胎儿情况:BPD组出生体重小于非BPD组、胎龄小于非BPD组,1 min Apgar评分≤7分、新生儿肺炎、新生儿败血症占比均高于非BPD组,机械通气时间长于非BPD组(P<0.05);孕母情况:BPD组羊膜早破>18 h、绒毛膜羊膜炎占比高于非BPD组,差异有统计学意义(P<0.05);胎龄、出生体重为超早产儿/超低出生体重儿发生BPD独立保护因素,机械通气时间、绒毛膜羊膜炎是超早产儿/超低出生体重儿发生BPD的独立危险因素(P<0.05)。基于多因素结果,构建logistic回归风险预测模型,Logit(P)在0~1,检验结果显示,该模型预测超早产儿/超低出生体重儿并发BPD的曲线下面积(AUC)为0.891(95%CI:0.846~0.939),Hosmer-Lemeshowχ^(2)=6.543,P=0.072。结论BPD的发生率在超早产儿/超低出生体重儿中明显升高,长时间机械通气、孕母绒毛膜羊膜炎是超早产儿/超低出生体重儿发生BPD的独立危险因素。基于上述因素构建logistic回归预测模型具有较高预测价值,可作为临床预测发生BPD的有效模型,并对后续临床决策具有一定指导意义。

高氧暴露BPD小鼠模型中巨噬细胞焦亡的检测及意义

目的 探讨巨噬细胞焦亡是否参与支气管肺发育不良(bronchopulmonary dysplasia,BPD)的肺病理损伤。方法 40只足月新生小鼠随机分为空气(room air,RA)组和高氧(hyperoxia,HO)组,每组20只。建立慢性高氧诱导的BPD小鼠模型。HE染色评估小鼠的肺泡化情况;CD31免疫组化检测肺血管发育状况;Masson染色分析肺组织的纤维化程度;qRT-PCR检测肺组织中的炎症因子和趋化因子(Il6、Il1b、Mmp12、Ccl2、Ccl5、Il8)基因表达水平;ELISA检测血清和肺组织匀浆中的IL-1β水平;Western blot检测细胞焦亡通路的关键蛋白NLRP3、Caspase-1 p20、N-消皮素D(gasdermin D,GSDMD)、IL-1β表达;流式分析支气管肺泡灌洗液中巨噬细胞比例;免疫荧光检测F4/80与NLRP3/Caspase-1/IL-1β的共定位;免疫组化分析AQP5的表达水平。结果 与RA组相比,HO组小鼠的肺泡化阻滞和肺血管生成障碍,肺纤维化显著增加;肺组织中促炎细胞因子的表达显著上调,细胞焦亡相关蛋白表达水平显著增加,血清和肺组织匀浆中IL-1β水平显著升高;支气管肺泡灌洗液中巨噬细胞比例显著升高,肺组织中F4/80与NLRP3、Caspase-1、IL-1β均存在显著的免疫荧光共定位现象,AQP5阳性的肺泡Ⅰ型上皮细胞严重受损。结论 高氧诱导的BPD小鼠模型中,NLRP3/Caspase-1/GSDMD细胞焦亡通路过度活化,可能导致BPD的肺部病理损伤。