包括中叶支气管的支气管热成形术显著改善重症哮喘患者肺功能及生活质量
2019/06/13
摘要
目的：支气管热成形术（BT）适用于进行大剂量药物治疗后仍有症状发作的重症哮喘患者。然而，目前指南不建议对右中叶（RML）支气管进行BT治疗。本研究的目的是研究对RML支气管进行BT治疗的安全性和有效性。
方法：17例患者进行BT治疗，探讨术前和术后90天生活质量和肺功能表现特点。此外，在每次BT后行支气管镜检查进行气道清理。本研究经埃森大学地方伦理委员会批准，并在德国临床试验中心注册为一项回顾性观察研究。
结果：FEV1和哮喘生活质量问卷（AQLQ）的基线水平中位数分别为1.33L（0.91; 1.73）及3.01（2.76; 3.61），治疗后90天的FEV1显著上升达1.75L（p值0.002）、AQLQ值达3.8（p值<0.05）。同时口服激素量也显著下降。BT过程中无严重不良事件发生。每次BT后进行的支气管镜检查可见明显的纤维蛋白渗出。
结论：包括RML支气管的BT是可行的。功能受限的重症哮喘患者可能会获益。由于BT治疗相关的纤维蛋白渗出，术后应该进行支气管镜检查以清理气道，而不仅限于RML支气管BT术后。
Bronchial Thermoplasty Including the Middle Lobe Bronchus Significantly Improves Lung Function and Quality of Life in Patients Suffering from Severe Asthma.
Eisenmann S, Schütte W, Funke F, Oezkan F, Islam S, DarwicheK.
Abstract
PURPOSE: Bronchial Thermoplasty (BT) is indicated in patients suffering from severe and symptomatic bronchial asthma despite maximal medical therapy. However,treatment of the right middle lobe (RML) bronchus is currently not recommended.The aim of this study was to investigate the safety and efficacy of BT if the RML bronchus is included.
METHODS: BT was performed in 17 consecutive patients,quality of life and pulmonary function were characterized before and 90 days after BT completion.Furthermore,we performed a clean-up bronchoscopy following every BT. This study was approved by the IRB of the University of Essen (No. 17-7356 BO) and registered as a retrospective observational study at the German Clinical Trials Registry (No. DRKS 00011550).
RESULTS: The median baseline values of FEV1 and Asthma Questionnaire of Life Quality(AQLQ) were 1.33L(0.91;1.73) and 3.01(2.76;3.61), respectively, and significantly improved 90 days after treatment with FEV1 at 1.75L(p-value 0.002) and AQLQ 3.8(p-value < 0.05). Also the amount of oral corticosteroid necessity decreased significantly. No severe adverse events occurred due to the procedure. Clean-up bronchoscopies-when performed-revealed significant fibrinous exudation after every BT procedure.
CONCLUSION: BT including the RML bronchus is feasible. Functionally limited patients with severe asthma could potentially profit. Due to the relevant fibrinous exudation, BT should be followed by clean-up bronchoscopy, not only after RML treatment.
目的：支气管热成形术（BT）适用于进行大剂量药物治疗后仍有症状发作的重症哮喘患者。然而，目前指南不建议对右中叶（RML）支气管进行BT治疗。本研究的目的是研究对RML支气管进行BT治疗的安全性和有效性。
方法：17例患者进行BT治疗，探讨术前和术后90天生活质量和肺功能表现特点。此外，在每次BT后行支气管镜检查进行气道清理。本研究经埃森大学地方伦理委员会批准，并在德国临床试验中心注册为一项回顾性观察研究。
结果：FEV1和哮喘生活质量问卷（AQLQ）的基线水平中位数分别为1.33L（0.91; 1.73）及3.01（2.76; 3.61），治疗后90天的FEV1显著上升达1.75L（p值0.002）、AQLQ值达3.8（p值<0.05）。同时口服激素量也显著下降。BT过程中无严重不良事件发生。每次BT后进行的支气管镜检查可见明显的纤维蛋白渗出。
结论：包括RML支气管的BT是可行的。功能受限的重症哮喘患者可能会获益。由于BT治疗相关的纤维蛋白渗出，术后应该进行支气管镜检查以清理气道，而不仅限于RML支气管BT术后。
（中日友好医院呼吸与危重症医学科 张 鑫 翻译 林江涛 审校）
（Lung. 2019 May 27. doi: 10.1007/s00408-019-00240-5）
（Lung. 2019 May 27. doi: 10.1007/s00408-019-00240-5）
Bronchial Thermoplasty Including the Middle Lobe Bronchus Significantly Improves Lung Function and Quality of Life in Patients Suffering from Severe Asthma.
Eisenmann S, Schütte W, Funke F, Oezkan F, Islam S, DarwicheK.
Abstract
PURPOSE: Bronchial Thermoplasty (BT) is indicated in patients suffering from severe and symptomatic bronchial asthma despite maximal medical therapy. However,treatment of the right middle lobe (RML) bronchus is currently not recommended.The aim of this study was to investigate the safety and efficacy of BT if the RML bronchus is included.
METHODS: BT was performed in 17 consecutive patients,quality of life and pulmonary function were characterized before and 90 days after BT completion.Furthermore,we performed a clean-up bronchoscopy following every BT. This study was approved by the IRB of the University of Essen (No. 17-7356 BO) and registered as a retrospective observational study at the German Clinical Trials Registry (No. DRKS 00011550).
RESULTS: The median baseline values of FEV1 and Asthma Questionnaire of Life Quality(AQLQ) were 1.33L(0.91;1.73) and 3.01(2.76;3.61), respectively, and significantly improved 90 days after treatment with FEV1 at 1.75L(p-value 0.002) and AQLQ 3.8(p-value < 0.05). Also the amount of oral corticosteroid necessity decreased significantly. No severe adverse events occurred due to the procedure. Clean-up bronchoscopies-when performed-revealed significant fibrinous exudation after every BT procedure.
CONCLUSION: BT including the RML bronchus is feasible. Functionally limited patients with severe asthma could potentially profit. Due to the relevant fibrinous exudation, BT should be followed by clean-up bronchoscopy, not only after RML treatment.
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