García-Laorden M Isabel, Lorente José A, Flores Carlos, Slutsky Arthur S, Villar Jesús
CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
Multidisciplinary Organ Dysfunction Evaluation Research Network, Research Unit, Hospital Universitario Dr. Negrin, Las Palmas de Gran Canaria, Spain.
Ann Transl Med. 2017 Jul;5(14):283. doi: 10.21037/atm.2017.06.49.
The acute respiratory distress syndrome (ARDS) is an acute inflammatory process of the lung caused by a direct or indirect insult to the alveolar-capillary membrane. Currently, ARDS is diagnosed based on a combination of clinical and physiological variables. The lack of a specific biomarker for ARDS is arguably one of the most important obstacles to progress in developing novel treatments for ARDS. In this article, we will review the current understanding of some appealing biomarkers that have been measured in human blood, bronchoalveolar lavage fluid (BALF) or exhaled gas that could be used for identifying patients with ARDS, for enrolling ARDS patients into clinical trials, or for better monitoring of patient's management. After a literature search, we identified several biomarkers that are associated with the highest sensitivity and specificity for the diagnosis or outcome prediction of ARDS: receptor for advanced glycation end-products (RAGE), angiopoietin-2 (Ang-2), surfactant protein D (SP-D), inteleukin-8, Fas and Fas ligand, procollagen peptide (PCP) I and III, octane, acetaldehyde, and 3-methylheptane. In general, these are cell-specific for epithelial or endothelial injury or involved in the inflammatory or infectious response. No biomarker or biomarkers have yet been confirmed for the diagnosis of ARDS or prediction of its prognosis. However, it is anticipated that in the near future, using biomarkers for defining ARDS, or for determining those patients who are more likely to benefit from a given therapy will have a major effect on clinical practice.
急性呼吸窘迫综合征（ARDS）是由肺泡-毛细血管膜直接或间接损伤引起的肺部急性炎症过程。目前，ARDS是根据临床和生理变量的组合来诊断的。缺乏ARDS的特异性生物标志物可以说是开发ARDS新疗法取得进展的最重要障碍之一。在本文中，我们将综述目前对一些有吸引力的生物标志物的认识，这些生物标志物已在人体血液、支气管肺泡灌洗液（BALF）或呼出气体中检测到，可用于识别ARDS患者、将ARDS患者纳入临床试验或更好地监测患者的治疗管理。经过文献检索，我们确定了几种与ARDS诊断或预后预测具有最高敏感性和特异性相关的生物标志物：晚期糖基化终产物受体（RAGE）、血管生成素-2（Ang-2）、表面活性蛋白D（SP-D）、白细胞介素-8、Fas和Fas配体、前胶原肽（PCP）I和III、辛烷、乙醛和3-甲基庚烷。一般来说，这些标志物对上皮或内皮损伤具有细胞特异性，或参与炎症或感染反应。目前尚无生物标志物被确证可用于ARDS的诊断或预后预测。然而，预计在不久的将来，使用生物标志物来定义ARDS或确定哪些患者更可能从特定治疗中获益将对临床实践产生重大影响。
