Wollborn J, Schlegel N, Schick M A
Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland.
Klinik und Poliklinik für Allgemein-, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Würzburg, Deutschland.
Anaesthesist. 2017 May;66(5):347-352. doi: 10.1007/s00101-017-0305-5.
Sepsis is commonly associated with loss of microvascular endothelial barrier function (capillary leak) and dysfunctional microcirculation, which both promote organ failure. The development of a distinct therapy of impaired endothelial barrier function and disturbed microcirculation is highly relevant because both of these phenomena constitute crucial processes which critically influence the prognosis of patients. Numerous in vivo and in vitro trials over the past years have fostered a better understanding of the pathophysiology of capillary leak. Furthermore, promising data in animal models show that therapeutic modulation of endothelial barrier function and microcirculation can be achieved by stabilizing endothelial cAMP (cyclic adenosine monophosphate) levels followed by activation of Rho-GTPase Rac1, e. g. by phosphodiesterase 4 inhibitors. This review summarizes and discusses recent findings of cellular mechanisms and in vivo trials.
脓毒症通常与微血管内皮屏障功能丧失（毛细血管渗漏）和微循环功能障碍相关，这两者都会促进器官衰竭。开发针对内皮屏障功能受损和微循环紊乱的独特治疗方法具有高度相关性，因为这两种现象都是严重影响患者预后的关键过程。过去几年中大量的体内和体外试验增进了我们对毛细血管渗漏病理生理学的理解。此外，动物模型中的有前景的数据表明，通过稳定内皮细胞环磷酸腺苷（cAMP）水平，随后激活Rho-GTPase Rac1，例如使用磷酸二酯酶4抑制剂，可以实现对内皮屏障功能和微循环的治疗性调节。本综述总结并讨论了细胞机制和体内试验的最新发现。
