机械通气诱发肺纤维化机制的研究进展  

Research advances of pulmonary fibrosis induced by mechanical ventilation

作　　者：王柏伦 张艺 谷长平[1] 张芮芮 王月兰[1] Wang Bailun;Zhang Yi;Gu Changping;Zhang Ruirui;Wang Yuelan(Department of Anesthesiology and Perioperative Medicine,the First Affiliated Hospital of Shandong First Medical University(Shandong Provincial Qianfoshan Hospital)&Shandong Institute of Anesthesia and Respiratory Intensive Care Medicine,Jinan 250014,China)

机构地区：[1]山东第一医科大学第一附属医院(山东省千佛山医院)麻醉与围术期医学科&山东省麻醉与呼吸重症研究所,济南250014

出　　处：《国际麻醉学与复苏杂志》2022年第11期1202-1206,共5页International Journal of Anesthesiology and Resuscitation

基　　金：国家自然科学基金(82070078)。

摘　　要：机械通气使用不当可引起或加重肺损伤,称为呼吸机所致肺损伤(ventilator-induced lung injury,VILI),机械通气导致的肺纤维化则是VILI中非常严重的一种。文章综述机械通气引起肺纤维化的可能机制,肺泡上皮细胞及肺血管内皮细胞转化为间充质细胞,巨噬细胞极化及肥大细胞产生胶原、类胰蛋白酶等,都参与机械通气诱发的肺纤维化;汇总了NOD样受体热蛋白结构域相关蛋白3(NOD-like receptor thermal protein domain associated protein 3,NLRP3)炎症小体、透明质酸(hyaluronic acid,HA)、中期因子(midkine,MK)、转化生长因子β(transforming growth factor-β,TGF-β)等细胞因子及Wnt等信号通路在机械通气肺纤维化中发挥的作用。文章多方面探索机械通气诱发肺纤维化的机制,为早期诊断及防治提供新思路。Recent studies have shown that improper use of mechanical ventilation can cause or aggravate lung injury,known as mechanical ventilator⁃associated lung injury(VILI).Pulmonary fibrosis caused by mechanical ventilation is severe in VILI.This pa⁃per reviews the possible mechanisms of pulmonary fibrosis induced by mechanical ventilation,including the transformation of alveolar epithelial cells and pulmonary vascular endothelial cells into mesenchymal cells,the excessive polarization of macrophages,and the production of collagen and trypsin⁃like cells by mast cells,all of which are involved in the pulmonary fibrosis induced by mechanical ventilation.In this paper,we summarized the roles of NOD⁃like receptor thermal protein domain associated protein 3(NLRP3)inflam⁃matory bodies,hyaluronic acid(HA),midkine(MK),transforming growth factor⁃β(TGF⁃β),and other cytokines as well as Wnt signal⁃ing pathways in mechanical ventilation of pulmonary fibrosis.Exploring the mechanism of pulmonary fibrosis induced by mechanical ventilation in various aspects provides new ideas for early diagnosis and prevention.

关 键 词：呼吸机所致肺损伤 肺纤维化 上皮-间质转化 细胞外基质 转化生长因子Β 

分 类 号：R563[医药卫生—呼吸系统]