应用三维CT断层扫描评价哮喘和哮喘-慢阻肺重叠患者的气道结构变化的差异
2020/01/02
摘要
背景：哮喘 - 慢性阻塞性肺病（COPD）重叠（ACO）是哮喘特征与COPD特征并发的临床表型。多排螺旋计算机断层扫描（MDCT）可用于评估气道结构;然而，我们对MDCT下哮喘和ACO之间的差异却知之甚少。
目的：为临床哮喘患者进行MDCT检查以研究哮喘和ACO之间气道结构的差异。
方法：将64名哮喘患者按条件分配到哮喘组（不吸烟或吸烟<10包/年）或ACO组（吸烟史≥10包/年且1秒内用力呼气量 [FEV1] /用力肺活量[FVC] <0.7）。哮喘组被进一步分为气流受限组（AL; FEV1 / FVC <0.7）和无AL组。使用MDCT评估实验组和29个健康对照者中三至五级支气管的壁厚（WT）和气道内腔面积。
结果：哮喘组共纳入43例患者（20例AL，23例无AL），ACO组共纳入16例患者。哮喘和ACO患者的WT均显著高于健康对照组。 ACO组的三级支气管WT显著高于哮喘组。将ACO组和哮喘并发AL组按年龄、病程和FEV1 / FVC配对后，ACO组中三级支气管的WT仍然高于AL组的哮喘。
结论：ACO患者的气道壁比哮喘患者更厚，这表明气道重塑在ACO中比在哮喘中更为突出。 UMIN 临床实验注册（UMIN-CTR）系统。
Differences in airway structural changes assessed by 3-dimensional computed tomography in asthma and asthma-chronic obstructive pulmonary disease overlap
Niwa M, et al. Ann Allergy Asthma Immunol. 2018 Dec.
Abstract
BACKGROUND: Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) is a clinical phenotype sharing features of asthma and COPD. Multidetector row computed tomography (MDCT) can be used to evaluate the airway structure; however, differences between asthma and ACO seen on MDCT are poorly understood.
OBJECTIVE: To investigate the difference in airway structural between asthma and ACO, using MDCT in patients with clinical asthma.
METHODS: Sixty-four patients with asthma were allocated to an asthma group (never smokers and ex-smokers with a smoking history of < 10 pack-years) or an ACO group (patients with a ≥10-pack-year smoking history and forced expiratory volume in 1 second [FEV1]/forced vital capacity [FVC] < 0.7). The asthma group was further divided into patients with airflow limitation (AL; FEV1/FVC < 0.7) and those without AL. Wall thickness (WT) and airway inner luminal area in the third-generation to fifth-generation bronchi were evaluated using MDCT in both study groups and in 29 healthy controls.
RESULTS: Forty-three patients were included in the asthma group (20 with AL, 23 without AL) and 16 in the ACO group. Patients with asthma and ACO had significantly greater WT than the healthy controls. WT in the third-generation bronchi was significantly greater in the ACO group than in the asthma group. The ACO group and the asthma with AL group were matched for age, disease duration, and FEV1/FVC. The WT in the third-generation bronchi was still greater in the ACO group than in the asthma with AL group.
CONCLUSION: Patients with ACO have a thicker airway wall than those with asthma, suggesting that airway remodeling is more prominent in ACO than in asthma. UMIN Clinical Trials Registry (UMIN-CTR) system (http://www.umin.ac.jp/ctr/UMIN000028913).
背景：哮喘 - 慢性阻塞性肺病（COPD）重叠（ACO）是哮喘特征与COPD特征并发的临床表型。多排螺旋计算机断层扫描（MDCT）可用于评估气道结构;然而，我们对MDCT下哮喘和ACO之间的差异却知之甚少。
目的：为临床哮喘患者进行MDCT检查以研究哮喘和ACO之间气道结构的差异。
方法：将64名哮喘患者按条件分配到哮喘组（不吸烟或吸烟<10包/年）或ACO组（吸烟史≥10包/年且1秒内用力呼气量 [FEV1] /用力肺活量[FVC] <0.7）。哮喘组被进一步分为气流受限组（AL; FEV1 / FVC <0.7）和无AL组。使用MDCT评估实验组和29个健康对照者中三至五级支气管的壁厚（WT）和气道内腔面积。
结果：哮喘组共纳入43例患者（20例AL，23例无AL），ACO组共纳入16例患者。哮喘和ACO患者的WT均显著高于健康对照组。 ACO组的三级支气管WT显著高于哮喘组。将ACO组和哮喘并发AL组按年龄、病程和FEV1 / FVC配对后，ACO组中三级支气管的WT仍然高于AL组的哮喘。
结论：ACO患者的气道壁比哮喘患者更厚，这表明气道重塑在ACO中比在哮喘中更为突出。 UMIN 临床实验注册（UMIN-CTR）系统。
(中国医科大学附属一院呼吸与危重症学科 李文扬 摘译 杨冬 审校)
(Niwa M, et al. Ann Allergy Asthma Immunol. 2018 Dec.)
(Niwa M, et al. Ann Allergy Asthma Immunol. 2018 Dec.)
Differences in airway structural changes assessed by 3-dimensional computed tomography in asthma and asthma-chronic obstructive pulmonary disease overlap
Niwa M, et al. Ann Allergy Asthma Immunol. 2018 Dec.
Abstract
BACKGROUND: Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) is a clinical phenotype sharing features of asthma and COPD. Multidetector row computed tomography (MDCT) can be used to evaluate the airway structure; however, differences between asthma and ACO seen on MDCT are poorly understood.
OBJECTIVE: To investigate the difference in airway structural between asthma and ACO, using MDCT in patients with clinical asthma.
METHODS: Sixty-four patients with asthma were allocated to an asthma group (never smokers and ex-smokers with a smoking history of < 10 pack-years) or an ACO group (patients with a ≥10-pack-year smoking history and forced expiratory volume in 1 second [FEV1]/forced vital capacity [FVC] < 0.7). The asthma group was further divided into patients with airflow limitation (AL; FEV1/FVC < 0.7) and those without AL. Wall thickness (WT) and airway inner luminal area in the third-generation to fifth-generation bronchi were evaluated using MDCT in both study groups and in 29 healthy controls.
RESULTS: Forty-three patients were included in the asthma group (20 with AL, 23 without AL) and 16 in the ACO group. Patients with asthma and ACO had significantly greater WT than the healthy controls. WT in the third-generation bronchi was significantly greater in the ACO group than in the asthma group. The ACO group and the asthma with AL group were matched for age, disease duration, and FEV1/FVC. The WT in the third-generation bronchi was still greater in the ACO group than in the asthma with AL group.
CONCLUSION: Patients with ACO have a thicker airway wall than those with asthma, suggesting that airway remodeling is more prominent in ACO than in asthma. UMIN Clinical Trials Registry (UMIN-CTR) system (http://www.umin.ac.jp/ctr/UMIN000028913).
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根据嗜酸细胞标志物（呼出一氧化氮或痰嗜酸细胞）进行哮喘治疗：一项系统回顾和荟萃分析
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