Pathophysiology of Acute Respiratory Distress Syndrome
Pathophysiology of Acute Respiratory Distress Syndrome
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DOI：
10.1007/978-3-319-41852-0_2
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
P. Silva;P. Rocco
中科院分区：
文献类型：
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作者：
P. Silva;P. Rocco
我们对急性呼吸窘迫综合征(ARDS)的病理生理学认识已取得重要进展，这在很大程度上是对参与该疾病的最重要细胞，如肺泡巨噬细胞、中性粒细胞、肺泡上皮细胞和内皮细胞的机制研究的结果。从巨噬细胞表型、中性粒细胞胞外陷阱、上皮细胞识别抗原到特定的表面活性物质释放和与内皮功能相关的生物标志物，每一种细胞类型的新途径都与ARDS的临床特征相一致。在临床环境中，有越来越多的证据表明有更好的ARDS表型识别。很明显，在肺表型和肺外表型之间，以及创伤表型、输血相关表型、癌症相关表型和脓毒症表型之间，生物标记物和预后存在差异。这种分层在其他呼吸系统疾病中也得到了应用，如哮喘和慢性阻塞性肺疾病，取得了有趣的结果，可能会改善ARDS的预后。
Important advances have been made in our understanding of acute respiratory distress syndrome (ARDS) pathophysiology, largely as the result of mechanistic studies about the most important cells involved in this condition, such as alveolar macrophages, neutrophils, and alveolar epithelial and endothelial cells. For each of these cell types, new pathways have been recognized in line with the clinical picture of ARDS, ranging from macrophage phenotypes, neutrophil extracellular traps, and antigen recognition by epithelial cells to specific surfactant release and biomarkers related to endothelial function. In the clinical setting, there is growing evidence for better ARDS phenotype recognition. It is clear that differences in biomarkers and prognosis exist between pulmonary and extrapulmonary phenotypes, as well as between traumatic, transfusion-related, cancer-related, and septic phenotypes. Such stratification has been done in other respiratory diseases, such as asthma and chronic obstructive pulmonary disease, with interesting results, and might improve outcomes in ARDS.