請簡單描述微血管、組織及淋巴管內滲透壓、 靜水壓的數據及相互關係

血漿中約有 90%的水分，這些是屬於細胞外液的一部份，他們會從微血管滲入
組織中，再由另一區域的組織滲回微血管，形成一個循環。水份由微血管滲入
組織或由組織滲入微血管，由四個力量決定，稱為史達林力(starling force)。這
四個力量為：
微血管靜水壓：將水份由微血管推向組織。(向外)
微血管膠體滲透壓：將水份拉在微血管內，不讓水分滲入組織。(向內)
組織靜水壓：將水份由組織推向微血管。(向內)
組織膠體滲透壓：將水份拉在組織內，不讓水分滲入微血管。(向外)
在靠近動脈端的微血管靜水壓約 37mmHg 在靠近靜脈端的微血管靜水壓約
17mmHg 微血管膠體滲透壓約 25mmHg 組織靜水壓約 1mmHg 組織膠體滲透壓
約 0mmHg 因此在微血管近動脈端的情況為(37+0)-(25+1)=11mmHg，水由微血管
移向組織，推力有 11mmHg。在微血管近靜脈端的情況為(17+0)-(25+1)=-
9mmHg，水由組織移向微血管，推力有 9mmHg。所以由微血管近動脈端滲出
的水分，大多從微血管近靜脈端再回到血管中。重點是，兩端之間相差的
2mmHg 力量，所以並不是一端滲出另一端完全回收，這差距換算出來的，大約
一天就有 2~4 公升的水分留在組織間。這些留在組織間的液體就滲入微淋巴
管，再匯入大淋巴管運送，最後進入主要淋巴管(胸管或右淋巴幹)，然後匯入鎖
骨下靜脈，再回到血液循環中。所以如果淋巴阻塞或淋巴循環不良，則易造成
組織水腫。
Source:http://higheredbcs.wiley.com/legacy/college/tortora/0470565101/hearthis_il
l/pap13e_ch21_illustr_audio_mp3_am/simulations/hear/capillary.html
闡述在腫瘤情形時上述關係有何變化
Malignant solid tumors generally have a higher interstitial fluid pressure (IFP) than
normal tissues. Tumor tissues develop interstitial hypertension because they show
high resistance to blood flow, low resistance to transcapillary fluid flow, and impaired
lymphatic drainage. The microvascular hydrostatic pressure is the principal driving
force for the elevated IFP of tumors. Fluid is forced from the microvasculature into
the interstitium where it accumulates, distends the extracellular matrix, and causes
interstitial hypertension. A pseudostable state is established with uniformly elevated
IFP throughout the tumor tissue except close to the surface, where the IFP drops
steeply to normal tissue values. Because of the steep IFP gradient at the tumor
surface, fluid oozes out from the tumor tissue into the surrounding normal tissue,
where it is collected by functional lymphatics.
Source: http://cancerres.aacrjournals.org/content/72/19/4899
闡述上述變化對藥物投送、免疫細胞聚集的影響
Tumors generate physical forces during growth and progression. These physical
forces are able to compress blood and lymphatic vessels, reducing perfusion rates
and creating hypoxia. When exerted directly on cancer cells, they can increase their
invasive and metastatic potential. Tumor vessels - while nourishing the tumor - are
usually leaky and tortuous, which further decreases perfusion. Hypo-perfusion and
hypoxia contribute to immune-evasion, promote malignant progression and
metastasis, and reduce the efficacy of a number of therapies, including radiation. In
parallel, vessel leakiness together with vessel compression cause a uniformly
elevated interstitial fluid pressure that hinders delivery of blood-borne therapeutic
agents, lowering the efficacy of chemo- and nano-therapies. In addition, shear
stresses exerted by flowing blood and interstitial fluid modulate the behavior of
cancer and a variety of host cells. Taming these physical forces can improve
therapeutic outcomes in many cancers.
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4109025/