Fehrenbach H, Wahlers T, Ochs M, Brasch F, Schmiedl A, Hirt S W, Haverich A, Richter J
Division of Electron Microscopy, Georg August University, Göttingen, Germany.
Virchows Arch. 1998 Mar;432(3):229-39. doi: 10.1007/s004280050160.
Alveolar type II pneumocytes (PII) were studied in 12 human donor lungs perfused with modified Euro-Collins solution during single-lung transplantation (SLTx). While one lung was transplanted, the contralateral donor lung (cDL) was fixed at the time of SLTx for examination by electron microscopy, stereology, and microanalysis. Three groups were then formed: group A (n = 7), cDL without contusions, uneventful early postoperative course; group B (n = 3), cDL with conclusions, uneventful early postoperative course; group C (n = 2), cDL without contusions, early postoperative respiratory dysfunction. The major findings were that the presence of contusions had no effect on PII ultrastructure and that intracellular surfactant-storing lamellar bodies of cDL in group C were characterized by a higher volume-to-surface ratio (VsR) and larger area per cell profile than group A. Correlation analysis based on pooled data (groups A and C) showed that ischaemic time had little effect on PII ultrastructure and bore no relationship to postoperative clinical variables. The duration of preoperative donor intubation had a pronounced influence on ultrastructure and postoperative clinical variables. The stereologically estimated amount of intracellular surfactant and mitochondrial VsR were the only ultrastructural parameters that were significantly associated with early postoperative oxygenation. Lamellar bodies were the only ultrastructural components found to have a significant relationship to postoperative intubation time. The ultrastructural integrity of type II pneumocytes of human donor lungs is an important determinant of early respiratory function following clinical lung transplantation.
在单肺移植（SLTx）期间，对12例灌注改良Euro-Collins溶液的人类供体肺中的II型肺泡上皮细胞（PII）进行了研究。在移植一侧肺的同时，对侧供体肺（cDL）在SLTx时固定，用于电子显微镜检查、体视学分析和微量分析。然后分为三组：A组（n = 7），cDL无挫伤，术后早期病程平稳；B组（n = 3），cDL有挫伤，术后早期病程平稳；C组（n = 2），cDL无挫伤，术后早期出现呼吸功能障碍。主要发现为，挫伤的存在对PII超微结构无影响，且C组cDL的细胞内储存表面活性剂的板层小体的特征是体积与表面积之比（VsR）较高，每个细胞轮廓的面积比A组大。基于汇总数据（A组和C组）的相关性分析表明，缺血时间对PII超微结构影响很小，且与术后临床变量无关。术前供体插管时间对超微结构和术后临床变量有显著影响。体视学估计的细胞内表面活性剂量和线粒体VsR是仅有的与术后早期氧合显著相关的超微结构参数。板层小体是唯一被发现与术后插管时间有显著关系的超微结构成分。人类供体肺II型肺上皮细胞的超微结构完整性是临床肺移植后早期呼吸功能的重要决定因素。
