Stone Jonathan, Robinson Stephen R, Mitrofanis John, Johnstone Daniel M
Discipline of Physiology, and Bosch Institute, University of Sydney, Sydney, NSW 2006, Australia.
School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC 3083, Australia.
Biomedicines. 2024 Sep 1;12(9):1969. doi: 10.3390/biomedicines12091969.
This review explores the hypothesis that dementia in several forms, chronic kidney disease and idiopathic pulmonary fibrosis have a common cause in pulse-induced capillary haemorrhage. All three conditions are age-related and characterised by insidious onset, uncertainty about their cause, exacerbation by hypertension, resistance to treatment and the relentlessness of their progression. We argue that the three conditions are the clinical outcomes of damage caused by pulse-induced haemorrhage from capillaries. The damage, first detectable in mid-life, creates first mild and then severe symptoms of cognitive, renal and pulmonary dysfunction. We also review evidence that in all three organs there has developed, by young adulthood, a reserve of tissue that enables them to function well, despite the 'heartbeat by heartbeat' damage that accumulates from early mid-life; and that it is when that reserve is exhausted, typically in late age, that symptoms of organ failure emerge and progress. If this common cause can be established, a step will have been taken towards the understanding, treatment and delay of three conditions that have their beginnings in every individual and that, in those who survive other causes of death, become lethal in late age.
本综述探讨了一种假说，即多种形式的痴呆症、慢性肾脏病和特发性肺纤维化都有一个共同的病因——脉搏诱导的毛细血管出血。这三种病症均与年龄相关，其特点是起病隐匿、病因不明、高血压会使其加重、对治疗有抵抗性且病情进展无情。我们认为，这三种病症是毛细血管脉搏诱导出血所造成损害的临床后果。这种损害在中年时首次可被检测到，最初会产生轻微的认知、肾脏和肺功能障碍症状，随后症状会加重。我们还回顾了相关证据，即在所有这三个器官中，到青年期时已形成了一种组织储备，使它们能够良好运作，尽管从中年早期开始就会累积“一次次心跳”造成的损害；而正是当这种储备耗尽时，通常是在老年时，器官衰竭的症状才会出现并加重。如果能够确定这个共同病因，那么在理解、治疗和延缓这三种始于每个人且在那些死于其他死因的人之外，在老年时会致命的病症方面就迈出了一步。
