Gut lymph and lymphatics: a source of factors leading to organ injury and dysfunction
Gut lymph and lymphatics: a source of factors leading to organ injury and dysfunction
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DOI：
10.1111/j.1749-6632.2010.05713.x
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发表时间：
2010-01-01
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影响因子：
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通讯作者：
Deitch, Edwin A.
中科院分区：
文献类型：
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作者：
Deitch, Edwin A.
严重创伤、休克、脓毒症等可导致急性呼吸窘迫综合征(ARDS)，进而发展为高度LEDS多器官功能障碍综合征(MODS)。虽然已经开始了一些治疗策略，但它们的成功在很大程度上是由于对MODS生物学的不完全了解。然而，最近的研究表明，肠道淋巴管是非细菌、组织损伤的肠源性因子的主要途径，可以诱发急性ARDS和MODS。因此，ARDS和MODS的肠道淋巴假说有助于澄清几个重要的问题。首先，因为肺是第一个暴露于肠系膜淋巴的器官，而不是肝脏(即，肠系膜淋巴通过胸腔导管进入锁骨下静脉，进而直接排入心脏和肺)，这可以解释临床观察，即肺通常是第一个衰竭的器官。其次，这一假说提供了新的病理生理学信息，从而为新的治疗方法提供了基础。最后，通过对淋巴成分的研究，可以分离和鉴定MODS的诱发因素。
Major trauma, shock, sepsis, and other conditions can lead to the acute respiratory distress syndrome (ARDS), which may progress to the highly lethalmultiple organ dysfunction syndrome (MODS). Although a number of therapeutic strategies have been initiated, their success has been limited largely due to an incomplete understanding of the biology of MODS. However, recent studies indicate that the intestinal lymphatics serve as the primary route for nonbacterial, tissue injurious gut-derived factors, which can induce acute ARDS and MODS. The gut lymph hypothesis of ARDS and MODS thus helps clarify several important issues. First, because the lung is the first organ exposed to mesenteric lymph and not the liver (i.e., mesenteric lymph enters the subclavian vein via the thoracic duct, which, in turn, empties directly into the heart and lungs), it would explain the clinical observation that the lung is generally the first organ to fail. Second, this hypothesis provides new pathophysiologic information, thereby providing a basis for novel therapies. Finally, by studying the composition of lymph, MODS-inducing factors can be isolated and identified.