Hoelz C, Negri E M, Lichtenfels A J, Conceção G M, Barbas C S, Saldiva P H, Capelozzi V L
Division of Respiratory Diseases, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
Pathol Res Pract. 2001;197(8):521-30.
The present study was undertaken in order to describe the morphological differences between pulmonary lesions in acute respiratory distress syndrome originating from direct pulmonary injury (ARDSp) and those originating from extrapulmonary injury (ARDSexp). We investigated a total of 38 ARDS-patients (27 males) ranging in age from 19 to 75 years, classified according to underlying disease in pulmonary (ARDSp) and extrapulmonary disease (ARDSexp). The extent of acute diffuse alveolar damage was assessed morphometrically on histologic gross sections in the upper and lower lobes of one lung. The lesions showed quantitative differences in extent and distribution according to underlying disease (primary pulmonary or secondary involvement). In pulmonary ARDS, a predominance of alveolar collapse (16.6%+/-12.3% versus 10.3%+/-11.9%, p = 0,03), fibrinous exudate (1.7%+/-3.2% versus 0.4%+/-1.1%, p = 0.01) and alveolar wall edema (11.2%+/-7.4% versus 6.6%+/-4.4%, p = 0,05) were found compared to extrapulmonary ARDS. We conclude that the morphology of acute diffuse alveolar damage (DAD) is mainly determined by underlying disease (pulmonary ARDS or extrapulmonary ARDS) differing in quantitative terms within the lung. Physiological, radiographic and respiratory system mechanics differences described in ARDSp and ARDSexp may therefore be due to morphometric differences in pulmonary lesions.
本研究旨在描述源于直接肺损伤的急性呼吸窘迫综合征（ARDSp）与源于肺外损伤的急性呼吸窘迫综合征（ARDSexp）肺部病变的形态学差异。我们共调查了38例ARDS患者（27例男性），年龄在19至75岁之间，根据潜在疾病分为肺部疾病（ARDSp）和肺外疾病（ARDSexp）。在一侧肺的上叶和下叶组织大体切片上，通过形态计量学评估急性弥漫性肺泡损伤的程度。病变在范围和分布上根据潜在疾病（原发性肺部或继发性受累）显示出数量差异。与肺外ARDS相比，在肺部ARDS中发现肺泡塌陷（16.6%±12.3%对10.3%±11.9%，p = 0.03）、纤维蛋白渗出物（1.7%±3.2%对0.4%±1.1%，p = 0.01）和肺泡壁水肿（11.2%±7.4%对6.6%±4.4%，p = 0.05）更为常见。我们得出结论，急性弥漫性肺泡损伤（DAD）的形态主要由潜在疾病（肺部ARDS或肺外ARDS）决定，在肺内存在数量差异。因此，ARDSp和ARDSexp中描述的生理、影像学和呼吸系统力学差异可能归因于肺部病变的形态计量学差异。
