Chronology of histological lesions in acute respiratory distress syndrome with diffuse alveolar damage: a prospective cohort study of clinical autopsies
Chronology of histological lesions in acute respiratory distress syndrome with diffuse alveolar damage: a prospective cohort study of clinical autopsies
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DOI：
10.1016/s2213-2600(13)70053-5
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发表时间：
2013-07-01
影响因子：
76.2
通讯作者：
Frutos-Vivar, Fernando
中科院分区：
文献类型：
--
作者：
Thille, Arnaud W.;Esteban, Andres;Frutos-Vivar, Fernando
研究背景急性呼吸窘迫综合征（ARDS）的组织学特征是肺泡损伤。然而，组织学病变的时间顺序尚未完全确定。我们的目的是确定时间的渗出性或增殖性变化和终末期纤维化的ARDS.Methods我们分析了1991年1月1日和2010年12月31日之间死亡的所有患者，在重症监护病房在赫塔菲大学医院，马德里，西班牙，谁有一个临床尸检。患者必须在死亡时具有ARDS的临床标准，并且在尸检时具有弥漫性肺泡损伤的组织学特征。毛细血管充血和肺泡内水肿特征的渗出phase，而肺泡细胞2型或成纤维细胞的增殖，或纤维化特征的增殖phase.Findings我们分析了159例患者。随着时间的推移，渗出性改变的发生率逐渐降低，在病程小于1周的82例ARDS患者中有74例（90%），病程1-3周的54例患者中有40例（74%），病程超过3周的23例患者中只有4例（17%）（P
Background Diff use alveolar damage is the histological hallmark of acute respiratory distress syndrome (ARDS). However, the chronology of histological lesions is not well established. We aimed to determine the time to onset of exudative or proliferative changes and end-stage fibrosis in ARDS.Methods We analysed all patients who died between Jan 1, 1991, and Dec 31, 2010, in the intensive-care unit at the Hospital Universitario de Getafe, Madrid, Spain, and who had a clinical autopsy. Patients had to have clinical criteria for ARDS at time of death and histological features of diffuse alveolar damage at autopsy examination. Capillary congestion and intra-alveolar oedema characterised the exudative phase whereas proliferation of alveolar cell type 2 or fibroblasts, or fibrosis characterised the proliferative phase.Findings We analysed 159 patients. The prevalence of exudative changes decreased over time, being reported in 74 (90%) of 82 patients with ARDS of less than 1 week duration, 40 (74%) of 54 patients with disease of 1-3 week duration, and only four (17%) of 23 patients with disease of longer than 3 weeks' duration (p