Acute Respiratory Distress Syndrome and Diffuse Alveolar Damage New Insights on a Complex Relationship
Acute Respiratory Distress Syndrome and Diffuse Alveolar Damage New Insights on a Complex Relationship
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DOI：
10.1513/annalsats.201609-728ps
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发表时间：
2017-06-01
影响因子：
8.3
通讯作者：
Matute-Bello, Gustavo
中科院分区：
文献类型：
--
作者：
Cardinal-Fernandez, Pablo;Lorente, Jose A.;Matute-Bello, Gustavo
急性呼吸窘迫综合征（ARDS）是一个严重的临床问题，具有较高的发病率和死亡率。弥漫性肺泡损伤（DAD）被认为是ARDS急性期的组织学标志。DAD的特征是急性期伴有水肿、透明膜和炎症，随后是机化期伴有肺泡间隔纤维化和II型肺细胞增生。由于在ARDS患者中获得活检的困难，DAD的存在不需要进行诊断。然而，活检和尸检研究表明，只有一半的患者符合ARDS的临床定义也有DAD。另一半被发现患有一组异质性疾病，包括肺炎。重要的是，患有DAD的ARDS患者亚组的死亡率似乎增加。这些患者对针对ARDS分子机制的特定治疗的反应可能与无DAD的患者不同。因此，开发无创性的DAD鉴别方法可能是重要的。基于非侵入性测量的DAD预测模型已在尸检队列中开发，但必须进行验证。这将是理想的，以确定生物标志物或成像技术，帮助确定哪些患者与ARDS有DAD。我们的结论是，需要进一步的研究来确定DAD对ARDS预后的影响，以及是否应该开发无创技术来识别DAD，以确定该人群对针对ARDS分子机制的特定治疗是否有不同的反应。
Acute respiratory distress syndrome (ARDS) is a major clinical problem with high morbidity and mortality. Diffuse alveolar damage (DAD) is considered the histological hallmark for the acute phase of ARDS. DAD is characterized by an acute phase with edema, hyaline membranes, and inflammation, followed by an organizing phase with alveolar septal fibrosis and type II pneumocyte hyperplasia. Given the difficulties in obtaining a biopsy in patients with ARDS, the presence of DAD is not required to make the diagnosis. However, biopsy and autopsy studies suggest that only one-half of patients who meet the clinical definition of ARDS also have DAD. The other half are found to have a group of heterogeneous disorders, including pneumonia. Importantly, the subgroup of patients with ARDS who also have DAD appears to have increased mortality. It is possible that the response of these patients to specific therapies targeting the molecular mechanisms of ARDS may differ from patients without DAD. Therefore, it may be important to develop noninvasive methods to identify DAD. A predictive model for DAD based on noninvasive measurements has been developed in an autopsy cohort but must be validated. It would be ideal to identify biomarkers or imaging techniques that help determine which patients with ARDS have DAD. We conclude that additional studies are needed to determine the effect of DAD on outcomes in ARDS, and whether noninvasive techniques to identify DAD should be developed with the goal of determining whether this population responds differently to specific therapies targeting the molecular mechanisms of ARDS.