先天性心脏病脑白质损伤研究进展  

Research progress of white matter injury following congenital heart disease

作　　者：刘刚[1] 祝忠群[1] 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心心胸外科,200127

出　　处：《国际儿科学杂志》2017年第8期519-522,共4页International Journal of Pediatrics

基　　金：上海市卫生局科研基金课题（20114121）;上海市教育委员会科研创新项目（13YZ027）;上海市科学技术委员会科研计划项目（14411964900）

摘　　要：先天性心脏病（congenital heart disease，CHD）是最常见的出生缺陷疾病。近年来，随着心脏外科技术的显著提升，复杂性CHD新生儿和婴幼儿的生存率已经明显提高。然而，神经性后遗症仍然常见并且高达25%～55%。CHD术后大脑损伤最主要的是白质（white matter，WM）损伤。研究表明，以脑室周围WM软化病为特点的WM损伤常见于CHD婴幼儿尤其是心脏外科术后。既往人们认为这是由于术中体外循环和外科手术操作引起。然而，随着外科手术、医疗诊断技术的不断进步和基础研究的不断深入，人们发现CHD患儿WM损伤是术前、术中、术后多重因素综合作用的结果。这些患儿生长发育后期出现的运动障碍、注意力和学习等方面的缺陷给家庭和社会带来巨大经济负担，降低了人口素质。因此，探究CHD患儿WM损伤的原因、机制和防治方法成为近年CHD脑损伤研究热点，也可能成为未来进一步显著改善CHD患儿神经发育损伤的重要研究方向。Congenital heart disease is the most common birth defect. With the significant improvements of cardiac surgical techniques,the survival of newborns and infants with complex congenital heart disease（CHD） has obviously been increased. However,neurological sequelae are still common and up to 25% -50%. The most important lesion after CHD surgery is white matter （WM） injury. Recent studies show that periventricular leukomalacia disease characterized by WM injury is common in CHD infants especially after cardiac surgery. It is previously thought to be due to the cardiopulmonary bypass and surgical operation. However, with the advances in surgery and medical diagnostic technology and development of basic research in recent years, it is discovered that WM injury in infants with CHD is a complex lesion influenced by preoperative, operating and postoperative factors. The movement disorders and the defects of attention, learning and other aspects in the late growth of these children bring a huge economic burden to the family and society, reducing the quality of the population. Therefore, exploring etiology, mechanisms and control methods of WM injury in infants with CHD becomes a hot topic in recent years, and it may also become an important direction for future research, aiming to the significant improvements in CHD children with neurodevelopmental damages.

关 键 词：先天性心脏病 白质损伤 脑室周围白质软化 复合体 神经发育损伤 

分 类 号：R725.4[医药卫生—儿科] R742[医药卫生—临床医学]