间质干细胞及急性肺损伤教材.pptVIP

Mesenchymal Stem Cells and Acute Lung Injury 间质干细胞及急性肺损伤 ARDS was first recognized in the 1960s1 as a clinical syndrome of severe acute respiratory failure presenting with hypoxemia and bilateral pulmonary infiltrates, most often in the setting of pneumonia, sepsis, or major trauma. ARDS最初在1960年，被人们认识为严重急性呼吸衰竭的临床综合征； 血氧不足和双边肺浸润，通常继发于肺炎、败血症、或严重的的创伤； distinction between (ALI) and ARDS relates to the severity of hypoxemia, with the former having a PaO2/FiO2 of less than 300, the latter with a PaO2/FiO2 of less than 200. lung endothelial injury, alveolar epithelial injury, the accumulation of protein-rich fluid 、cellular debris in the alveolar space 急性肺损伤(ALI)和ARDS的区别主要指血氧不足严重程度，前者有PaO2 /FIO2小于300; 后者PaO2 /FIO2不足200; ALI / ARDS的发病机制涉及肺血管内皮损伤, 肺泡上皮损伤,富含蛋白质液体的增加和肺泡腔内的细胞残骸. 流行病学 2005年,大约200000名患者在美国发展为 ALI / ARDS,估计有40%的死亡率。 采用肺保护性通气时代,死亡率下降大约25%。 In 2005, approximately 200,000 pts in the United States ALI/ARDS, with an estimated mortality of 40%. In the era of lung protective ventilation, mortality has declined to approximately 25%. 大量的临床试验,药物治疗吸入表面活性剂（ inhaled surfactant ）、一氧化氮（ nitric oxide ）、前列环素（ prostacyclins）,糖皮质激素（ glucocorticoids）,抗氧化剂（antioxidants）, 酮康唑（ketoconazole）并非ALI治疗标准； ALI肺泡的病理生理，任何单一分子不可能逆转综合症的过程，使临床获益； reverse the course of this syndrome 、provide substantial clinical benefit. 细胞为基础的疗法 cell-based therapies 能产生炎症分子 molecules 调节炎症反应 modulate inflammatory cascades 增强修复 enhance repair 间充质干细胞可能是理想的选择 Mesenchymal Stem Cells（MSC） 间充质干细胞:一般属性 间充质干细胞(msc) self-renewing isolated from bone marrow differentiate into muscle, bone, fat, fibroblasts, and cartilage. 能重建造血的环境 reconstitute a hematopoietic environment , regenerate bone tissue； 起初被称为成纤维细胞的集落形成单位colonyforming unit-fibroblastic ，(CFU-F)； 骨髓基质细胞marrow stromal cells, MSC 仍然不知道间充质干细胞是否来自中胚层,或者神经上皮,或来自不同来源的发展阶段 whether MSCs originate from the mesoderm, from the neuroepithelium, or from different sources MSC 骨髓、脂肪,脐带血,胎盘组织、肌腱和骨骼肌、 bone marrow 、also from fat, umbilical cord blood, pla