Golden Michael Henry
Paediatr Int Child Health. 2015 May;35(2):90-109. doi: 10.1179/2046905515Y.0000000010. Epub 2015 Apr 6.
The various types of oedema in man are considered in relation to Starling's hypothesis of fluid movement from capillaries, with the main emphasis on nutritional oedema and the nephrotic syndrome in children. It is concluded that each condition has sufficient anomalous findings to render Starling's hypothesis untenable. The finding that the endothelial glycocalyx is key to control of fluid movement from and into the capillaries calls for complete revision of our understanding of oedema formation. The factors so far known to affect the function of the glycocalyx are reviewed. As these depend upon sulphated proteoglycans and other glycosaminoglycans, the argument is advanced that the same abnormalities will extend to the interstitial space and that kwashiorkor is fundamentally related to a defect in sulphur metabolism which can explain all the clinical features of the condition, including the formation of oedema.
本文结合斯塔林关于液体从毛细血管流动的假说，对人类各种类型的水肿进行了探讨，主要侧重于营养性水肿和儿童肾病综合征。得出的结论是，每种情况都有足够多的异常发现，使得斯塔林假说难以成立。内皮糖萼是控制液体进出毛细血管的关键这一发现，要求我们对水肿形成的理解进行彻底修正。本文回顾了目前已知影响糖萼功能的因素。由于这些因素依赖于硫酸化蛋白聚糖和其他糖胺聚糖，因此有人提出，相同的异常情况也会延伸到间质间隙，并且夸休可尔症从根本上与硫代谢缺陷有关，这可以解释该病症的所有临床特征，包括水肿的形成。
