Farrell P M, Avery M E
Am Rev Respir Dis. 1975 May;111(5):657-88. doi: 10.1164/arrd.1975.111.5.657.
In addition to confirmation of earlier epidemiologic observations, major advances have occurred in the past few years with respect to the diagnosis and treatment of hyaline membrane disease. Prenatal assessment of the risk for developing the disorder is now routinely possible by amniocentesis and analysis of the ratio of lecithin to sphingomyelin in amniotic fluid, or by surfactant titer ("shake test"). Such predictability and numerous other lines of evidence provide strong support for the hypothesis that hyaline membrane disease fundamentally reflects a deficiency of pulmonary surfactant. In accordance with the apparent primacy of surfactant deficiency, recent improvements in management are directed toward either increasing lung volume at end expiration by application of continuous distending airway pressure, or accelerating fetal lung maturation, with respect to the synthesis and secretion of surfactant, by prenatal administration of glucocorticoids.
除了证实早期的流行病学观察结果外，在过去几年中，关于透明膜病的诊断和治疗也取得了重大进展。现在，通过羊膜穿刺术和分析羊水卵磷脂与鞘磷脂的比例，或通过表面活性剂滴度（“振荡试验”），常规地可以对患该疾病的风险进行产前评估。这种可预测性和众多其他证据有力地支持了这样一种假说，即透明膜病从根本上反映了肺表面活性剂的缺乏。根据表面活性剂缺乏的明显首要地位，最近管理方面的改进旨在通过应用持续气道扩张压力在呼气末增加肺容积，或通过产前给予糖皮质激素来加速胎儿肺成熟，以促进表面活性剂的合成和分泌。
