From the Departments of Pediatric Intensive Care (L.R.A.S., A.P.B., R.M.W.-v.A.), Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (L.R.A.S., M.J.S., N.P.J.), and Neonatology (A.H.v.K.), Academic Medical Center, Amsterdam, The Netherlands.
Anesthesiology. 2015 Aug;123(2):389-408. doi: 10.1097/ALN.0000000000000687.
Advanced age is associated with an increased susceptibility and mortality of the acute respiratory distress syndrome. This may be due to the progressive changes in innate immune responses and intrinsic properties of the lung that occur during the process of aging. Therefore, this study assesses the association between maturation and aging and pulmonary responses to injury in animal models of lung injury.
A systematic search was conducted in PubMed, EMBASE (up to June 2014) and in the references of relevant articles to identify the studies using in vivo models of lung injury caused by an acute pulmonary insult, in which at least two age groups were compared. Because methodological diversity precluded combining these studies in a quantitative meta-analysis, data are presented based on the qualitative comparison with the adult group.
Of the 2,840 identified studies, 51 were included in this review. Most studies showed that, in response to a pulmonary insult, increasing age is associated with more pulmonary inflammation, edema, alveolar damage, and higher mortality. In addition, results indicate the existence of age-dependent changes in key components of the intracellular signaling pathways involved in the inflammatory response.
Increasing age seems to be correlated with exaggerated pulmonary responses to injury, ultimately leading to more severe lung injury. Pulmonary inflammation seems relatively suppressed in infants/juveniles, whereas in the middle aged/elderly, the inflammatory response seems delayed but aggravated. This implies that investigators and clinicians need to use caution about extrapolating results from adolescent or youngadult animals to pediatric or elderly patients in clinical practice.
高龄与急性呼吸窘迫综合征的易感性和死亡率增加有关。这可能是由于在衰老过程中固有免疫反应和肺的固有特性发生的渐进性变化所致。因此，本研究评估了肺损伤动物模型中成熟和衰老与肺对损伤的反应之间的关系。
在 PubMed、EMBASE（截至 2014 年 6 月）和相关文章的参考文献中进行了系统搜索，以确定使用急性肺损伤动物模型的研究，其中至少比较了两个年龄组。由于方法学的多样性使得这些研究无法进行定量荟萃分析，因此根据与成年组的定性比较来呈现数据。
在确定的 2840 项研究中，有 51 项被纳入本综述。大多数研究表明，随着年龄的增长，在受到肺损伤时，肺炎症、水肿、肺泡损伤和死亡率增加。此外，结果表明，在参与炎症反应的细胞内信号转导途径的关键成分中存在年龄依赖性变化。
年龄的增加似乎与对损伤的过度肺反应相关，最终导致更严重的肺损伤。在婴儿/青少年中，肺炎症似乎相对受到抑制，而在中年/老年中，炎症反应似乎延迟但加重。这意味着研究人员和临床医生在临床实践中需要谨慎地将青少年或年轻成年动物的结果外推到儿科或老年患者。
