胎盘功能障碍与胎儿生长受限:基础研究与临床创新的桥梁

Placental dysfunction and fetal growth restriction:a bridge between basic research and clinical innovation

摘要

胎儿生长受限(FGR)是影响新生儿预后的重要临床疾病,在医疗资源不足地区尤为高发。本病不仅显著增加围产期死亡风险,还与远期神经发育障碍及心血管代谢疾病密切相关。从发病机制看,胎盘功能障碍是FGR的核心环节,涉及血管生成失衡、代谢紊乱、炎症反应等多重病理过程。就临床诊疗而言,目前主要依靠一系列超声监测,结合脐动脉血流频谱、子宫动脉搏动指数等血流动力学指标进行综合评估。治疗上仍面临挑战,缺乏特效药物,主要采取营养支持和个体化产科管理方案。目前精准医疗为胎盘源性FGR诊治带来新机遇。因此,通过文献系统综述,可深化对胎盘源性FGR的发病机制和临床管理的认识。这一认识一方面有助于建立规范化的产前监测体系,推动精准诊断;另一方面有助于促进多学科协作诊疗模式的建立,为个体化治疗提供依据。

Abstract

Fetal growth restriction (FGR) is a significant clinical condition affecting neonatal prognosis,especially prevalent in regions with limited medical resources.This condition not only significantly increases the risk of perinatal mortality but is also closely associated with long-term neurodevelopmental disorders and cardiovascular metabolic diseases.From a pathogenic perspective,placental dysfunction is the core link of FGR,involving multiple pathological processes such as vascular dysregulation,metabolic disorders,and inflammatory responses.In terms of clinical diagnosis and treatment,current approaches mainly rely on a series of ultrasound monitoring,combined with hemodynamic indicators such as umbilical artery blood flow spectrum and uterine artery pulsatility index for comprehensive assessment.Treatment remains challenging,with a lack of specific drugs,and mainly involves nutritional support and individualized obstetric management plans.Currently,precision medicine offers new opportunities for the diagnosis and treatment of placenta-originated FGR.Therefore,through a systematic literature review,a deeper understanding of the pathogenesis and clinical management of placenta-originated FGR can be achieved.This understanding,on one hand,helps establish a standardized prenatal monitoring system and promotes precise diagnosis;on the other hand,it facilitates the establishment of a multidisciplinary collaborative diagnosis and treatment model,providing a basis for individualized treatment.

关键词

胎儿生长受限 / 发病机制 / 精准医疗 / 胎盘功能障碍 / 产前监测

Key words

fetal growth restriction / pathogenesis / precision medicine / placental dysfunction / prenatal monitoring

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基金资助

国家自然科学基金(82401976)

国家卫生健康委医药卫生科技发展研究中心(WKZX2024DN0113)

湖北省自然科学基金(2023AFB238)