Department of Pediatrics, Division of Critical Care, University of California San Francisco , San Francisco, CA , USA.
Department of Pediatrics, Division of Critical Care, University of California San Francisco, San Francisco, CA, USA; Department of Pediatrics, Division of Critical Care, University of California Los Angeles, Los Angeles, CA, USA.
Front Pediatr. 2016 Jun 1;4:55. doi: 10.3389/fped.2016.00055. eCollection 2016.
Acute respiratory distress syndrome (ARDS) is common among mechanically ventilated children and accompanies up to 30% of all pediatric intensive care unit deaths. Though ARDS diagnosis is based on clinical criteria, biological markers of acute lung damage have been extensively studied in adults and children. Biomarkers of inflammation, alveolar epithelial and capillary endothelial disruption, disordered coagulation, and associated derangements measured in the circulation and other body fluids, such as bronchoalveolar lavage, have improved our understanding of pathobiology of ARDS. The biochemical signature of ARDS has been increasingly well described in adult populations, and this has led to the identification of molecular phenotypes to augment clinical classifications. However, there is a paucity of data from pediatric ARDS (pARDS) patients. Biomarkers and molecular phenotypes have the potential to identify patients at high risk of poor outcomes, and perhaps inform the development of targeted therapies for specific groups of patients. Additionally, because of the lower incidence of and mortality from ARDS in pediatric patients relative to adults and lack of robust clinical predictors of outcome, there is an ongoing interest in biological markers as surrogate outcome measures. The recent definition of pARDS provides additional impetus for the measurement of established and novel biomarkers in future pediatric studies in order to further characterize this disease process. This chapter will review the currently available literature and discuss potential future directions for investigation into biomarkers in ARDS among children.
急性呼吸窘迫综合征（ARDS）在机械通气的儿童中很常见，约占所有儿科重症监护病房死亡人数的 30%。尽管 ARDS 的诊断基于临床标准，但急性肺损伤的生物标志物已在成人和儿童中进行了广泛研究。在循环和其他体液（如支气管肺泡灌洗）中测量的炎症、肺泡上皮和毛细血管内皮破坏、凝血紊乱以及相关紊乱的生物标志物，提高了我们对 ARDS 病理生理学的认识。ARDS 的生化特征在成人人群中越来越被充分描述，这导致了识别分子表型来增强临床分类。然而，儿科 ARDS（pARDS）患者的数据很少。生物标志物和分子表型有可能识别出预后不良风险较高的患者，并可能为特定患者群体的靶向治疗提供信息。此外，由于儿科患者 ARDS 的发病率和死亡率相对较低，且缺乏可靠的预后临床预测指标，因此人们一直对生物标志物作为替代终点测量方法感兴趣。最近 pARDS 的定义为未来儿科研究中测量既定和新型生物标志物以进一步描述这一疾病过程提供了额外的动力。本章将回顾目前可用的文献，并讨论在儿童 ARDS 中研究生物标志物的潜在未来方向。
