Rocker G M, Wiseman M S, Pearson D, Shale D J
Respiratory Medicine Unit, University of Nottingham.
Lancet. 1989 Jan 21;1(8630):120-3. doi: 10.1016/s0140-6736(89)91142-2.
To assess whether current diagnostic criteria for the adult respiratory distress syndrome (ARDS) may limit research to patients with a range of severity of respiratory failure and risk factors for ARDS were studied. In 28 patients ARDS did not develop; in 9 it did; and the other 13 met the diagnostic criteria at their first assessment. Plasma concentration of neutrophil elastase-alpha 1-antitrypsin complex was higher in all groups than in controls. For all patients, plasma elastase-complex was related to worsening hypoxia and to increased bronchoalveolar lavage protein content. Elastase-complex was present in all bronchoalveolar lavage samples and was related to protein content and differential neutrophil counts. Patients at risk of or with ARDS had a spectrum of respiratory failure to which intravascular and intra-alveolar neutrophil elastase release and capillary permeability were related. This suggests that the state recognised as ARDS is not a distinct pathophysiological entity.
为评估成人呼吸窘迫综合征（ARDS）的现行诊断标准是否会将研究局限于具有一定范围呼吸衰竭严重程度的患者，我们对ARDS的危险因素进行了研究。28例患者未发生ARDS；9例发生了ARDS；另外13例在首次评估时符合诊断标准。所有组的中性粒细胞弹性蛋白酶-α1-抗胰蛋白酶复合物血浆浓度均高于对照组。对所有患者而言，血浆弹性蛋白酶复合物与缺氧加重及支气管肺泡灌洗蛋白含量增加有关。弹性蛋白酶复合物存在于所有支气管肺泡灌洗样本中，且与蛋白含量及中性粒细胞分类计数有关。有ARDS风险或患有ARDS的患者存在一系列呼吸衰竭情况，血管内和肺泡内中性粒细胞弹性蛋白酶释放及毛细血管通透性与之相关。这表明被认定为ARDS的状态并非一个独特的病理生理实体。
