Department of Pediatrics, Division of Critical Care Medicine, University of California, San Francisco and Benioff Children's Hospitals, San Francisco, CA, USA.
Curr Opin Pediatr. 2018 Jun;30(3):332-337. doi: 10.1097/MOP.0000000000000623.
The essential role of the lymphatic system in fluid homeostasis, nutrient transport, and immune trafficking is well recognized; however, there is limited understanding of the mechanisms that regulate lymphatic function, particularly in the setting of critical illness. The lymphatics likely affect disease severity and progression in every condition, from severe systemic inflammatory states to respiratory failure. Here, we review structural and functional disorders of the lymphatic system, both congenital and acquired, as they relate to care of the pediatric patient in the intensive care setting, including novel areas of research into medical and procedural therapeutic interventions.
The mainstay of current therapies for congenital and acquired lymphatic abnormalities has involved nonspecific medical management or surgical procedures to obstruct or divert lymphatic flow. With the development of dynamic contrast-enhanced magnetic resonance lymphangiography, image-directed percutaneous intervention may largely replace surgery. Because of new insights into the mechanisms that regulate lymphatic biology, pharmacologic inhibitors of mTOR and leukotriene B4 signaling are each in Phase II clinical trials to treat abnormal lymphatic structure and function, respectively.
As our understanding of normal lymphatic biology continues to advance, we will be able to develop novel strategies to support and augment lymphatic function during critical illness and through convalescence.
目的综述：人们已经充分认识到淋巴系统在体液平衡、营养物质运输和免疫细胞运输方面的重要作用；然而，对于调节淋巴功能的机制，特别是在危重病的情况下，人们的了解仍然有限。从严重的全身炎症状态到呼吸衰竭，淋巴系统可能会影响每种情况下的疾病严重程度和进展。在这里，我们回顾了先天性和获得性淋巴系统的结构和功能障碍，以及它们与儿科患者在重症监护环境中的护理的关系，包括对医学和程序治疗干预的新研究领域。
最新发现：目前先天性和获得性淋巴异常的主要治疗方法包括非特异性药物治疗或手术来阻塞或转移淋巴液流动。随着动态对比增强磁共振淋巴造影术的发展，图像引导的经皮介入可能在很大程度上取代手术。由于对调节淋巴生物学的机制有了新的认识，mTOR 和白三烯 B4 信号的药理学抑制剂分别在治疗异常淋巴结构和功能的 II 期临床试验中，分别用于治疗异常的淋巴结构和功能。
总结：随着我们对正常淋巴生物学的理解不断深入，我们将能够开发出支持和增强危重病期间和恢复期淋巴功能的新策略。
