Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo City, Tokyo, 104-8560, Japan.
Department of Radiology, St. Luke's International Hospital, Tokyo, Japan.
BMC Pulm Med. 2022 Aug 11;22(1):308. doi: 10.1186/s12890-022-02102-y.
Although diffuse alveolar damage (DAD) is a histopathological hallmark of acute respiratory distress syndrome (ARDS), its detection without lung biopsy is challenging. In patients with ARDS, the specificity of the Berlin definition to diagnose DAD as a reference standard is not adequately high, making it difficult to adequately diagnose DAD. The purpose of this study was to investigate the relationship between DAD and clinical findings, including KL-6 and geographic appearance, in ARDS patients and to identify more specific diagnostic criteria for DAD.
Among all adult autopsy cases at a tertiary hospital in Japan between January 2006 and March 2021, patients with ARDS who met the Berlin definition criteria were included. The patients' conditions were classified according to histopathological patterns as DAD or non-DAD, and clinical characteristics, laboratory data, and high-resolution computed tomography (HRCT) findings were compared between the two groups.
During the study period, 27 met the Berlin definition (median age: 79 years, 19 men), of whom 18 (67%) had DAD and 9 (33%) did not. In the non-DAD group, histopathologic findings revealed organizing pneumonia in seven patients and pulmonary hemorrhage in two patients. On HRCT at onset, patients with DAD had more geographic appearance than those without DAD (89% vs. 44%). In patients with geographic appearance and elevated KL-6 (> 500 U/mL), the sensitivity and specificity for DAD diagnosis were 56% and 100%, respectively. All three patients with no geographic appearance and normal KL-6 did not have DAD.
Geographic appearance on HRCT combined with KL-6 levels may predict the presence of DAD in patients with ARDS.
虽然弥漫性肺泡损伤（DAD）是急性呼吸窘迫综合征（ARDS）的组织病理学标志，但在没有肺活检的情况下检测它具有挑战性。在 ARDS 患者中，柏林定义作为参考标准诊断 DAD 的特异性不够高，因此难以充分诊断 DAD。本研究的目的是探讨 ARDS 患者中 DAD 与临床发现（包括 KL-6 和地理外观）之间的关系，并确定 DAD 更特异的诊断标准。
在日本一家三级医院 2006 年 1 月至 2021 年 3 月间所有成人尸检病例中，纳入符合柏林定义标准的 ARDS 患者。根据组织病理学模式将患者分为 DAD 或非 DAD 组，并比较两组之间的临床特征、实验室数据和高分辨率计算机断层扫描（HRCT）结果。
在研究期间，符合柏林定义的患者有 27 例（中位年龄：79 岁，19 名男性），其中 18 例（67%）有 DAD，9 例（33%）没有。在非 DAD 组，组织病理学发现 7 例患者为机化性肺炎，2 例患者为肺出血。在发病时的 HRCT 上，DAD 患者比非 DAD 患者更具有地理外观（89%对 44%）。在具有地理外观和升高的 KL-6（>500 U/mL）的患者中，DAD 诊断的敏感性和特异性分别为 56%和 100%。所有 3 例无地理外观和正常 KL-6 的患者均无 DAD。
HRCT 上的地理外观与 KL-6 水平相结合可能预测 ARDS 患者中 DAD 的存在。
