Galatius S, Bent-Hansen L, Wroblewski H, Kastrup J
The Heart Center, The Rigshospital, Copenhagen, Denmark.
Am J Cardiol. 2000 Apr 1;85(7):843-8. doi: 10.1016/s0002-9149(99)00878-4.
The total extracellular fluid volume and distribution in plasma and interstitial spaces, and the microvascular permeability properties were studied in 16 nonedematous patients with congestive heart failure (CHF) due to idiopathic dilated cardiomyopathy and 17 such patients who underwent heart transplantation (HT) by analyzing the 3-hour plasma disappearance curve of polyfructosan. Eighteen healthy subjects served as controls. Polyfructosan (3.5 kD) is an extracellular marker and inulin analog transported almost solely by diffusion. The initial capillary membrane plasma clearance (i.e., the permeability-surface area product), the interstitial plasma clearance determined at 10 minutes (clearance[10), and the extracellular volume were determined from the polyfructosan curves. I-131-albumin was used as a plasma volume reference. Permeability-surface area product was elevated in both patient groups (6.6 +/- 1.9 ml/ kg/min in the CHF group and 6.7 +/- 2.0 ml/kg/min in the HT group vs 5.1 +/- 1.3 ml/kg/min in controls, p <0.01 for both), whereas clearance(10) was normalized in the HT group (4.5 +/- 0.9 ml/kg/min in the HT group, 4.4 +/- 0.7 ml/kg/min in controls vs 5.0 +/- 0.9 ml/kg/ min in the CHF group, p <0.1 and p <0.05, respectively). The normalization of interstitial plasma clearance of polyfructosan was associated with time since HT (r = 0.49, p <0.05). Plasma volumes were similar in all 3 groups (41 +/- 8 ml/kg in controls, 44 +/- 13 in the CHF group and 39 +/- 8 in the HT group). In contrast, total extracellular volume was elevated in both patients groups (177 +/- 27 ml/kg in the CHF group and 173 +/-27 in the HT group vs 152 +/- 12 in controls, p <0.01). The results strongly suggest a microvascular permeability defect in both patient groups that perhaps plays a role in the extravascular distribution of the excess extracellular fluid volume.
通过分析多聚果糖的3小时血浆消失曲线，研究了16例因特发性扩张型心肌病导致的充血性心力衰竭（CHF）非水肿患者和17例接受心脏移植（HT）的此类患者的细胞外液总体积及其在血浆和间质间隙中的分布，以及微血管通透性特性。18名健康受试者作为对照。多聚果糖（3.5kD）是一种细胞外标志物，是一种几乎仅通过扩散转运的菊粉类似物。从多聚果糖曲线确定初始毛细血管膜血浆清除率（即通透性-表面积乘积）、10分钟时测定的间质血浆清除率（清除率[10]）和细胞外液体积。I-131-白蛋白用作血浆容量参考。两组患者的通透性-表面积乘积均升高（CHF组为6.6±1.9ml/kg/min，HT组为6.7±2.0ml/kg/min，而对照组为5.1±1.3ml/kg/min，两组p均<0.01），而HT组的清除率（10）恢复正常（HT组为4.5±0.9ml/kg/min，对照组为4.4±0.7ml/kg/min，而CHF组为5.0±0.9ml/kg/min，p分别<0.1和<0.05）。多聚果糖间质血浆清除率的恢复正常与心脏移植后的时间相关（r = 0.49，p <0.05）。三组的血浆容量相似（对照组为41±8ml/kg，CHF组为44±13ml/kg，HT组为39±8ml/kg）。相反，两组患者的细胞外液总体积均升高（CHF组为177±27ml/kg，HT组为173±27ml/kg，而对照组为152±12ml/kg，p <0.01）。结果强烈提示两组患者均存在微血管通透性缺陷，这可能在过量细胞外液体积的血管外分布中起作用。
