INTACT EPITHELIAL BARRIER FUNCTION IS CRITICAL FOR THE RESOLUTION OF ALVEOLAR EDEMA IN HUMANS
INTACT EPITHELIAL BARRIER FUNCTION IS CRITICAL FOR THE RESOLUTION OF ALVEOLAR EDEMA IN HUMANS
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DOI：
10.1164/ajrccm/142.6_pt_1.1250
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发表时间：
1990-12-01
期刊：
影响因子：
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通讯作者：
WIENERKRONISH, JP
中科院分区：
文献类型：
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作者：
MATTHAY, MA;WIENERKRONISH, JP
在气管插管后15分钟内，通过（1）连续测量肺泡-动脉氧差，（2）初始和随访胸片上的水肿程度，和（3）通过肺水肿液的连续样品中总蛋白和白蛋白浓度的初始和最终测量。根据氧合和胸部放射学数据，24例患者临床改善，10例患者无改善。在10名临床上没有改善的患者中（3名，流体静力性水肿; 7名，渗透性水肿），最终水肿液蛋白浓度没有变化（4.1 . ±. 1.1 g/100 ml）与初始水肿液蛋白浓度（4.2 . ±. 1.0 g/100 ml）（p = ns）。然而，在临床上改善的24名患者中（15名，流体静力性水肿; 9名，渗透性水肿），每个患者的最终水肿蛋白浓度都增加（5.6 ± 0.01）。2.3 g/100 ml），与它们的初始水肿蛋白浓度（3.8 ± 0.1g/100 ml）相比，1.2 g/100ml）（p < 0.01）。在这24名患者中的13名中，最终水肿液浓度（7.3 ±. 1.6 g/100 ml）超过了最终的血浆蛋白浓度（5.6 ± 0.01g/100 ml）。0.8 g/100 ml），平均值为1.7 g/100 ml蛋白质。这些数据提供了人类的第一个证据，以支持这一假设，即主动离子转运通过肺泡上皮屏障是清除水肿液从肺的空气空间的主要机制。此外，连续使用肺水肿液蛋白浓度作为肺泡上皮屏障功能的指标，为16例通透性增加的肺水肿患者的生存提供了一个良好的预后指标。
Within 15 min of endotracheal intubation, the resolution of pulmonary edema was studied over the next 12 h in 34 mechanically ventilated patients by (1) serial measurements of the alveolar-arterial oxygen difference, (2) the extent of edema on the initial and follow-up chest radiograph, and (3) by an initial and final measurement of total protein and albumin concentration in sequential samples of pulmonary edema fluid. Based on the oxygenation and chest radiographic data, 24 patients clinically improved and 10 patients did not improve. In the 10 patients who did not clinically improve (3, hydrostatic edema; 7, permeability edema), there was no change in the final edema fluid protein concentration (4.1 .+-. 1.1 g/100 ml) compared with the initial edema fluid protein concentration (4.2 .+-. 1.0 g/100 ml) (p = ns). However, in the 24 patients who clinically improved (15, hydrostatic edema; 9, permeability edema), there was an increase in every patient''s final edema protein concentration (5.6 .+-. 2.3 g/100 ml) compared with their initial edema protein concentration (3.8 .+-. 1.2 g/100 ml) (p < 0.01). In 13 of these 24 patients, the final edema fluid concentration (7.3 .+-. 1.6 g/100 ml) exceeded the final plasma protein concentration (5.6 .+-. 0.8 g/100 ml) by a mean value of 1.7 g/100 ml protein. The data provide the first evidence in humans to support the hypothesis that active ion transport across the alveolar epithelial barrier is the primary mechanism for clearance of edema fluid from the air spaces of the lung. In addition, the use of sequential pulmonary edema fluid protein concentration as an index of alveolar epithelial barrier function provided a good prognostic indicator of survival in the 16 patients with increased permeability pulmonary edema.