Causes and prognosis of diffuse alveolar damage diagnosed on surgical lung biopsy
Causes and prognosis of diffuse alveolar damage diagnosed on surgical lung biopsy
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DOI：
10.1378/chest.07-0104
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发表时间：
2007-07-01
期刊：
影响因子：
9.6
通讯作者：
Ryu, Jay H.
中科院分区：
文献类型：
--
作者：
Parambil, Joseph G.;Myers, Jeffrey L.;Ryu, Jay H.
背景：弥漫性肺泡损伤（DAD）是尸检中相对常见的组织病理学发现，特别是在ARDS死亡患者中，可由多种原因引起。经外科肺活检诊断的DAD的病因和相关预后意义尚不清楚。在1996年1月至2002年12月的7年间，我们确定了58例连续通过外科肺活检诊断为DAD的患者。对这些患者的临床放射学特征、病因和临床病程进行了研究。结果：中位年龄为61岁，48%为女性，60%为免疫功能低下。90%的患者在外科肺活检时符合ARDS标准。胸片显示双侧实质浸润，而CT主要显示磨玻璃和实变影。感染是DAD最常见的原因（22%）。其他原因包括造血干细胞或实体器官移植引起的非感染性肺部并发症（17%）、结缔组织疾病（16%）、特发性肺纤维化急性加重（12%）、药物（10%）和放射治疗（2%）。12名患者（21%）患有急性间质性肺炎（即没有可识别的病因或DAD易感条件）。总体住院死亡率为53%，最高死亡率（86%）发生在DAD表现为特发性肺纤维化急性加重的患者中。结论：我们的研究表明，感染和急性间质性肺炎是手术肺活检诊断的DAD最常见的原因。与DAD相关的医院死亡率可能因潜在原因而异。
Background: Diffuse alveolar damage (DAD) is a relatively common histopathologic finding at autopsy, particularly in patients dying with ARDS, and can result from a variety of causes. The spectrum of causes and associated prognostic implications for DAD diagnosed by surgical lung biopsy are unclear.Methods. We identified 58 consecutive patients with DAD diagnosed by surgical lung biopsy over a 7-year period, January 1996 through December 2002. The presenting clinicoradiologic features, causes, and clinical course of these patients were studied.Results: The median age was 61 years, 48% were women, and 60% were immunocompromised. Ninety percent of patients fulfilled the criteria for ARDS at the time of surgical lung biopsy. Chest radiography demonstrated bilateral parenchymal infiltrates, while CT revealed predominantly ground-glass and consolidative opacities. Infections were the most common cause of DAD (22%). Other causes were noninfectious pulmonary complications of hematopoietic stem-cell or solidorgan transplantation (17%), connective tissue diseases (16%), acute exacerbation of idiopathic pulmonary fibrosis (12%), drugs (10%), and radiation therapy (2%). Twelve patients (21%) had acute interstitial pneumonia (ie, no identifiable cause or predisposing condition for DAD). Overall hospital mortality was 53%, with the highest mortality (86%) occurring among patients for whom DAD represented acute exacerbation of idiopathic pulmonary fibrosis.Conclusion: Our study showed that infections and acute interstitial pneumonia are the most common causes of DAD diagnosed by surgical lung biopsy. Hospital mortality rate associated with DAD may vary depending on the underlying cause.