哮喘联盟

   摘要
   背景：异质性的气道狭窄和闭塞是哮喘的特点。然而，从来没有通过影像所得到的平行同类气道的数据进行直接测量，并且这个过程的解剖学原理仍然是未知的。
   方法：7例正常的受试者以及9例哮喘的受试者在给予乙酰甲胆碱前后分别接受高分辨率CT检查。分别测量28和24级平行同类气道（从同一分叉升起的气管对）得到全呼吸道的平均腔内面积(直径范围1.0-8.7 mm)。异质性狭窄被定义为平行同类气道间狭窄百分比的中位差异。在仰卧位时测量给予乙酰甲胆碱激发前后的强迫振荡呼吸阻力(Rrs)和呼吸流量。
   结果：基线时哮喘患者的气道更小，并且在支气管收缩后哮喘和非哮喘组存在相似的FEV1降低，Rrs 增加以及平均的气道狭窄。为了达到相同的改变，非哮喘患者比哮喘患者需要更高剂量的乙酰甲胆碱。然而，哮喘患者的平行异质性(中位(IQR) 33% (27-53%) vs 11% (9-18%), p<0.001)和气道闭塞(24.1% 和 7.7%, p=0.001, χ2)较非哮喘患者更严重。
   结论：我们发现了哮喘患者组气道表现差异的清晰证据。哮喘患者的气道在基线时更狭窄并且吸入乙酰甲胆碱后平行同类气道异质性狭窄更明显、气道闭塞更显著。
 

（杨冬 审校）
Thorax. 2015 Sep 9. pii: thoraxjnl-2014-206387.doi:10.1136/thoraxjnl-2014-206387. [Epub ahead of print]


 

Greater parallel heterogeneity of airway narrowing and airway closure in asthma measured by high-resolution CT.
 

Dame Carroll JR1, Magnussen JS2, Berend N3, Salome CM1, King GG4.
 

Abstract
BACKGROUND:Heterogeneous airway narrowing and closure are characteristics of asthma. However, they have never been quantified by direct measurements of parallel sister airways obtained from image data, and the anatomical basis of these processes remains unknown.
METHODS:Seven normal and nine asthmatic subjects underwent high-resolution CT, before and after methacholine challenge. Mean lumen areas of the entire airways were measured in 28 and 24 parallel sister airway pairs (a pair of airways arising from the same bifurcation) respectively (range 1.0-8.7 mm diameter). Heterogeneous narrowing was defined as the median difference in percentage narrowing between parallel sister airways. Forced oscillatory respiratory resistance (Rrs) and spirometry were measured before and after methacholine challenge conducted while supine.
RESULTS:The airways of asthmatics were smaller at baseline, and following bronchoconstriction there were similar decreases in FEV1, increases in Rrs and mean narrowing of airways for asthmatic and non-asthmatic groups. Non-asthmatics required higher doses of methacholine than asthmatics to achieve the same changes. However, parallel heterogeneity (median (IQR) 33% (27-53%) vs 11% (9-18%), p<0.001) and airway closure (24.1% and 7.7%, p=0.001, χ2) were greater in asthmatics versus non-asthmatics.
CONCLUSION:We found clear evidence of differences in airway behaviour in the asthmatic group. Asthmatic airways were narrower at baseline and responded to inhaled methacholine by more heterogeneous narrowing of parallel sister airways and greater airway closure.
 

Thorax. 2015 Sep 9. pii: thoraxjnl-2014-206387.doi:10.1136/thoraxjnl-2014-206387. [Epub ahead of print]