Center for General Internal Medicine and Education, School of Medicine, Keio University, Tokyo, 160-8582 Japan.
J Intensive Care. 2014 May 7;2(1):32. doi: 10.1186/2052-0492-2-32. eCollection 2014.
Acute respiratory distress syndrome (ARDS) is defined as an acute-onset, progressive, hypoxic condition with radiographic bilateral lung infiltration, which develops after several diseases or injuries, and is not derived from hydrostatic pulmonary edema. One specific pathological finding of ARDS is diffuse alveolar damage. In 2012, in an effort to increase diagnostic specificity, a revised definition of ARDS was published in JAMA. However, no new parameters or biomarkers were adopted by the revised definition. Discriminating between ARDS and other similar diseases is critically important; however, only a few biomarkers are currently available for diagnostic purposes. Furthermore, predicting the severity, response to therapy, or outcome of the illness is also important for developing treatment strategies for each patient. However, the PaO2/FIO2 ratio is currently the sole clinical parameter used for this purpose. In parallel with progress in understanding the pathophysiology of ARDS, various humoral factors induced by inflammation and molecules derived from activated cells or injured tissues have been shown as potential biomarkers that may be applied in clinical practice. In this review, the current understanding of the basic pathophysiology of ARDS and associated candidate biomarkers will be discussed.
急性呼吸窘迫综合征（ARDS）定义为多种疾病或损伤后突发、进行性、低氧血症，影像学表现为双肺浸润，其并非源于静水压性肺水肿。ARDS 的一个特定的病理学发现是弥漫性肺泡损伤。2012 年，为了提高诊断特异性，JAMA 发表了 ARDS 的修订定义。然而，修订定义并未采用新的参数或生物标志物。区分 ARDS 和其他类似疾病至关重要；然而，目前仅存在少数几种用于诊断目的的生物标志物。此外，预测疾病的严重程度、对治疗的反应或转归对于为每位患者制定治疗策略也很重要。然而，目前仅使用 PaO2/FIO2 比值作为该目的的唯一临床参数。随着对 ARDS 病理生理学认识的进展，由炎症引起的各种体液因子和源自激活细胞或受损组织的分子已被证明是可能应用于临床实践的潜在生物标志物。在本综述中，将讨论目前对 ARDS 基本病理生理学和相关候选生物标志物的理解。
