Pathology of arrested acinar development in postsurfactant bronchopulmonary dysplasia
Pathology of arrested acinar development in postsurfactant bronchopulmonary dysplasia
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DOI：
10.1016/s0046-8177(98)90280-5
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发表时间：
1998-07-01
期刊：
影响因子：
3.3
通讯作者：
Stocker, JT
中科院分区：
文献类型：
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作者：
Husain, AN;Siddiqui, NH;Stocker, JT
为明确肺表面活性物质治疗的支气管肺发育不良(BPD)患者的病理改变，我们回顾了22例BPD患者(S治疗14例，非表面活性物质治疗8例)和15例年龄匹配的对照组，这些患者的肺经福尔马林膨胀后处理。研究对象包括肺表面活性物质治疗、妊娠后年龄、头臀长度、尸检时体重、放射状肺泡计数(RAC)、平均线截距(MLI)、RAC/MLI比值以及纤维化的数量和程度。三色染色显示对照组未见肺泡间隔纤维化，而14例S-BPD患者中有5例出现轻至中度的肺泡间隔纤维化，其中3例大部分或全部腺泡有纤维化。相比之下，8个NS-BPD中有7个在整个肺内散布的腺泡中有7个有中到重度的肺泡间隔纤维化。这些患者被分成两组，第一组死亡时怀孕40周，为受孕后年龄。在第1组中，S-BPD组(9例)的RAC显著低于对照组(7例)，平均值分别为4.14和5.13(P=0.016)，而NS-BPD组(4例)的RAC和MLI在S-BPD组和NS-BPD组均无统计学差异。在调整年龄大于足月的患者中，衡量腺泡复杂性的平均RAG在S-BPD组(5例)和NS-BPD组(4例)分别为3.89和3.90，而对照组(8例)为5.79(P=.0007)。用来衡量肺泡大小的MLI值，S-BPD组和NS-BPD组分别为0.21和0.17，均显著高于对照组的平均值0.12(P=0.003)。RAC/MLI比值的比较显示相似的统计学差异。根据这些结果，我们得出结论：(1)S-BPD的肺泡间隔纤维化的数量明显少于PR-BPD，且趋于弥漫；(2)出生后，S-BPD和NS-BPD的腺泡发育(肺泡囊和肺泡)部分或完全停止；(3)尽管组织学检查显示有微小的变化，但RAG和MLI；它们的比率可用于支持BPD的诊断和帮助评估S-BPD所发生的肺损伤程度。版权所有(C)1998年，W.B.桑德斯公司。
To define the pathology of bronchopulmonary dysplasia (BPD) in surfactant-treated patients (S-BPD), we reviewed 22 BPD patients (14 S-BPD and eight nonsurfactant-treated [NS-BPD]) and 15 age-matched controls, the lungs from which had been processed after formalin inflation. These were studied for surfactant therapy, postconceptional age, crown-rump length, weight at autopsy, radial alveolar count (RAC), mean linear intercept (MLI), RAC/MLI ratio, and amount and extent of fibrosis. On trichrome staining, there was no alveolar septal fibrosis in the control group, whereas there was mild to moderate alveolar septal fibrosis in 5 of 14 S-BPD patients, of which three had fibrosis in most or all of the acini. In contrast, seven of eight NS-BPD had moderate to severe alveolar septal fibrosis in scattered acini throughout the lung. The patients were divided into two groups, with the first group having a postconceptional age at the time of death of up to 40 weeks' gestation. In group 1, the RAC in S-BPD (nine patients) was significantly lower than that of the controls (seven patients); mean, 4.14 and 5.13, respectively (P =.016), whereas the RAC in the NS-BPD (four patients) and the MLI in both S-BPD and NS-BPD were not statistically significantly different. In group 2, those with adjusted age greater than term, the mean RAG, a measure of acinar complexity, was 3.89 in the S-BPD (five patients) and 3.90 in the NS-BPD (four patients),whereas in the control group (eight patients), it was 5.79 (P =.0007). The mean MLI, a measure of alveolar size, was 0.21 and 0.17 in the S-BPD and NS-BPD groups, respectively, each of which was significantly greater than the mean value of 0.12 in the control group (P =.0003). The comparison of RAC/MLI ratios showed similar statistically significant differences. Based on these results, we conclude that (1) the amount of alveolar septal fibrosis is substantially less and tends to be more diffuse in S-BPD than in Pr'S-BPD; (2) during the period after birth, there is a partial to complete arrest in acinar development (alveolar saccular and alveolar) of similar severity for S-BPD and NS-BPD; and (3) even though on histological examination there are minimal changes, RAG, MLI; and their ratio may be used to support the diagnosis of BPD and help in assessing the amount of lung damage that occurs in S-BPD. Copyright (C) 1998 by W.B. Saunders Company.