Kobashi Y, Manabe T
Department of Human Pathology, Kawasaki Medical School, Okayama, Japan.
Virchows Arch A Pathol Anat Histopathol. 1993;422(1):47-52. doi: 10.1007/BF01605132.
On the assumption that some cases of organized diffuse alveolar damage (DAD) result from organization of hyaline membrane, we collected nine autopsy cases of DAD in various stages of the fibrosing process from hyaline membrane to membranous fibrosis and studied changes in the basement membrane and epithelial cells immunohistochemically. In the majority of cases, the following sequence of events was assumed: the hyaline membrane is first formed at the tip of the alveolar septum, a part of the alveolar duct wall where epithelial cells have disappeared. With time it elongates and completely covers alveolar mouths. In the organizing stage, fibroblasts start to permeate through the alveolar duct walls to replace the hyaline membrane completely and to form membranous fibrous tissue. In a few cases, however, fibrous tissue will fill alveolar spaces to form intraluminal diffuse fibrosis. Alveolar epithelial cells and the basement membrane of the alveolar walls are well preserved until the end of the organizing stage when the basement membrane becomes distorted. We believe that membranous fibrosis represents a form of "alveolar duct damage" and that it differs from diffuse fibrosis, which is indicative of diffuse alveolar damage in the true sense.
基于部分机化性弥漫性肺泡损伤（DAD）病例是由透明膜机化所致的假设，我们收集了9例处于从透明膜到膜性纤维化纤维化过程不同阶段的DAD尸检病例，并通过免疫组织化学方法研究了基底膜和上皮细胞的变化。在大多数病例中，推测发生了以下一系列事件：透明膜首先在肺泡间隔的尖端形成，肺泡间隔是肺泡管壁的一部分，此处上皮细胞已经消失。随着时间的推移，它会伸长并完全覆盖肺泡口。在机化阶段，成纤维细胞开始穿过肺泡管壁，完全取代透明膜并形成膜性纤维组织。然而，在少数情况下，纤维组织会填充肺泡腔形成腔内弥漫性纤维化。肺泡上皮细胞和肺泡壁基底膜在机化阶段结束前都保存完好，此时基底膜会发生扭曲。我们认为膜性纤维化代表了一种“肺泡管损伤”形式，它与弥漫性纤维化不同，弥漫性纤维化才是真正意义上的弥漫性肺泡损伤的指标。
