The Effective Lymphatic Absorption Rate is an Accurate and Useful Concept in the Physiology of Peritoneal Dialysis
The Effective Lymphatic Absorption Rate is an Accurate and Useful Concept in the Physiology of Peritoneal Dialysis
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有效淋巴吸收率是腹膜透析生理学中一个准确且有用的概念
DOI：
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发表时间：
2004
影响因子：
2.8
通讯作者：
R. Krediet
中科院分区：
文献类型：
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作者：
R. Krediet
309本版《国际腹膜透析》（PDI）中介绍的一个专题题为“腹膜透析中的争议”。会议的形式将是辩论。每个参与者将提出赞成或反对辩论动议的论点。这些论点将以简明的评注形式提出，并根据需要提供数字、表格和参考资料。然后，编辑向每个参与者提出一些问题;提供问题和答案。目的是把注意力集中在两种对立观点之间的关键差异上，希望能帮助我们的读者得出自己的结论。在这一期的PDI中，最初的争论是关于腹膜生理学家见面时产生的争论，这就是腹膜淋巴流量到底是什么以及应该用什么术语来描述它的问题。当然，淋巴流量是通过估计淋巴从腹膜腔中清除大分子来间接测量的。然而，所有人都同意，大分子从腹膜腔中消失的速率与血液中相同大分子的出现速率之间存在差异。也有共识认为，这种差异是由于透析液留置期间大分子从腔体进入腹壁组织所致。由Raymond Krediet领导的Amsterdam研究小组长期倡导的一种观点是，这些大分子最终会被局部淋巴管从腹壁重吸收，因此应该包括在腹膜淋巴引流总量的任何估计中。为了表达这一点，阿姆斯特丹小组提出了术语“有效淋巴吸收率”（ELAR）。其他人，包括Michael Flessner，认为ELAR是一个误导性和不恰当的术语，并且在任何腹膜淋巴流量的估计中不应考虑离开腔体进入腹壁组织的大分子。这些争论随着米歇尔斯等人在本期PDI上发表的一篇论文再次达到高潮，阿姆斯特丹小组的成员，使用ELAR这个术语。我想，读者会喜欢克雷迪特和弗莱斯纳提出的清晰简洁的论点。虽然他们可能会得出结论，这两个杰出的腹膜生理学研究者之间的一些差异是语义上的，但也很明显，其他差异是真实的，代表了对一个根本性的重要概念的对比解释。争论的实质似乎集中在腹膜停留期间从腹膜腔进入腹壁组织的大分子的最终命运上。这些分子最终是穿过腹膜回到血流中，还是从腹膜腔到腹壁组织来回移动？答案可能是，最终解决这一争议的关键实验尚未进行。在这一点上，我必须向我们的两位辩论者致敬。不管谁对谁错，应该指出的是，知识是通过在有争议的领域中提出并努力回答重要问题的有条理的聪明的调查人员之间交换意见而发展起来的。Krediet和Flessner发展他们的论点和回应问题的过程读起来很精彩。他们愿意诚实、简洁和直接地解决关键问题，这令人钦佩。请读者通过写信给编辑来回应这场辩论。计划每年在PDI中至少出现两次这样的“腹膜透析争议”。欢迎反馈。
309 A feature introduced in this edition of Peritoneal Dialysis International (PDI) is entitled “Controversies in Peritoneal Dialysis.” The format will be that of a debate. Each participant will present arguments in favor of or against the motion for debate. The arguments will be in the form of a concise commentary, with figures, tables, and references as required. The Editor then poses a number of questions to each participant; the questions and responses are provided. The aim is to focus attention on the key differences between the two adversarial points of view in the hope of helping our readers reach their own conclusions. The initial debate, in this issue of PDI, deals with a controversy that arises whenever peritoneal physiologists meet, this is, the question of what peritoneal lymphatic flow really is and what terminology should be used to describe it. Lymphatic flow is, of course, measured indirectly by estimation of lymphatic removal of macromolecules from the peritoneal cavity. All agree, however, that there is a discrepancy between the disappearance rate of macromolecules from the peritoneal cavity and the appearance rate of the same macromolecules in the blood. There is also consensus that this difference is accounted for by the egress of macromolecules from the cavity into the tissues of the abdominal wall during a dialysate dwell. One point of view, long advocated by the Amsterdam group, led by Raymond Krediet, is that these macromolecules will eventually be reabsorbed from the abdominal wall by local lymphatics and so should be included in any estimate of total peritoneal lymphatic drainage. To express this, the Amsterdam group has proposed the term “effective lymphatic absorption rate” (ELAR). Others, including Michael Flessner, have argued that the ELAR is a misleading and inappropriate term and that macromolecules that exit the cavity into abdominal wall tissues should not be considered in any estimation of peritoneal lymphatic flow. These arguments have again come to a head with the publication in this issue of PDI of a paper by Michels et al., of the Amsterdam group, that uses the term ELAR. Readers will, I think, enjoy the clear and concise arguments put forward by Krediet and Flessner. While they may conclude some of the differences between these two outstanding peritoneal physiology investigators are semantic, it is also clear that others are real and represent contrasting interpretations of a fundamentally important concept. The essence of the argument would seem to center on the ultimate fate of macromolecules that enter the abdominal wall tissues from the peritoneal cavity during a peritoneal dwell. Do these molecules end up traversing the lymphatics back to the blood stream or do they go back and forth from the peritoneal cavity to the abdominal wall tissues? The answer may be that the key experiments to conclusively resolve this controversy have not yet been performed. At this point, I must pay tribute to our two debaters. Regardless of who is right or wrong, it should be stated that knowledge is advanced by the exchange of views between articulate intelligent investigators who ask and strive to answer important questions in areas of controversy. The process by which Krediet and Flessner develop their arguments and respond to questions is wonderful to read. Their willingness to address the key issues honestly, concisely, and directly is admirable. Readers are invited to respond to this debate with letters to the Editor. The plan is for at least two such “Controversies in Peritoneal Dialysis” to appear annually in PDI. Feedback would be welcome.
影响因子：
3
作者：
Drake,RE;Gabel,JC
通讯作者：
Gabel,JC
小鼠腹膜吸收的淋巴和非淋巴途径：生理学与病理学。
影响因子：
3
作者：
Nagy,JA
通讯作者：
Nagy,JA