哮喘的实质破坏：固定气流阻塞和肺功能轨迹
2021/09/24
摘要
背景：哮喘尤其是非吸烟哮喘的固定气流阻塞（FAO）通常被认为是由气道重塑引起的。然而，实质破坏也可能导致FAO和1秒用力呼气量（FEV1）的纵向下降。
目的：使用肺气肿指数，指数D和计算机断层扫描（CT）的低衰减面积百分比（LAA%）评估实质破坏，并测试实质破坏和气道疾病是否与吸烟/不吸烟哮喘患者的FAO和FEV1下降独立相关。
方法：吸气CT上测量哮喘患者的D，LAA%，节段性气道壁面积百分比（WA%）和气道分形维数（AFD），并与慢性阻塞性肺病（COPD）患者进行比较。
结果：FAO (N = 101)的哮喘及COPD (N = 42)患者较无FAO (N = 88)的患者有更低的指数D及更高的LAA%。无论吸烟状况或哮喘严重程度如何，D减少和LAA%增加都与FAO有关。在多变量分析中，无论WA%和AFD如何，D降低和LAA%增加与FAO的优势比增加和FEV1降低相关。此外，D降低影响重症哮喘患者FEV1的纵向下降，与吸烟状况无关。
结论：无论吸烟状况和哮喘严重程度如何，具有FAO的哮喘患者都表现出实质性破坏。实质破坏与FEV1加速下降有关，提示气道和实质参与了哮喘亚组的病理生理过程。
Parenchymal destruction in asthma: Fixed airflow obstruction and lung function trajectory
Kaoruko Shimizu, Naoya Tanabe, Akira Oguma, Hirokazu Kimura, Masaru Suzuki, Isao Yokota, Hironi Makita, Susumu Sato, Toyohiro Hirai, Masaharu Nishimura, Satoshi Konno, Hi-CARAT investigators
Abstract
Background: Fixed airflow obstruction (FAO) in asthma, particularly in non-smoking subjects, is generally believed to be caused by airway remodeling. However, parenchymal destruction may also contribute to FAO and longitudinal decline in forced expiratory volume in 1 sec (FEV1).
Objectives: To evaluate parenchymal destruction using emphysema indices, exponent D and low attenuation area percent (LAA%) on computed tomography (CT), and test whether the parenchymal destruction and airway disease are independently associated with FAO and FEV1 decline in both smoking and non-smoking asthma.
Methods: D, LAA%, wall area percent (WA%) at segmental airways, and airway fractal dimension (AFD) in asthmatics were measured on inspiratory CT and compared to those in chronic obstructive pulmonary disease (COPD) patients.
Results: D was lower and LAA% was higher in COPD (N = 42) and asthma with FAO (N = 101) than in asthma without FAO (N = 88). The decreased D and increased LAA% were associated with FAO regardless of smoking status or asthma severity. In multivariable analysis, decreased D and increased LAA% were associated with an increased odds ratio of FAO and decreased FEV1, irrespective of WA% and AFD. Moreover, decreased D affected the longitudinal decline in FEV1 in severe asthmatics, independent of smoking status.
Conclusions: Asthmatics with FAO showed the parenchymal destruction regardless of smoking status and asthma severity. The parenchymal destruction was associated with an accelerated FEV1 decline, suggesting the involvements of both airway and parenchyma in the pathophysiology of a subgroup of asthma.
背景：哮喘尤其是非吸烟哮喘的固定气流阻塞（FAO）通常被认为是由气道重塑引起的。然而，实质破坏也可能导致FAO和1秒用力呼气量（FEV1）的纵向下降。
目的：使用肺气肿指数，指数D和计算机断层扫描（CT）的低衰减面积百分比（LAA%）评估实质破坏，并测试实质破坏和气道疾病是否与吸烟/不吸烟哮喘患者的FAO和FEV1下降独立相关。
方法：吸气CT上测量哮喘患者的D，LAA%，节段性气道壁面积百分比（WA%）和气道分形维数（AFD），并与慢性阻塞性肺病（COPD）患者进行比较。
结果：FAO (N = 101)的哮喘及COPD (N = 42)患者较无FAO (N = 88)的患者有更低的指数D及更高的LAA%。无论吸烟状况或哮喘严重程度如何，D减少和LAA%增加都与FAO有关。在多变量分析中，无论WA%和AFD如何，D降低和LAA%增加与FAO的优势比增加和FEV1降低相关。此外，D降低影响重症哮喘患者FEV1的纵向下降，与吸烟状况无关。
结论：无论吸烟状况和哮喘严重程度如何，具有FAO的哮喘患者都表现出实质性破坏。实质破坏与FEV1加速下降有关，提示气道和实质参与了哮喘亚组的病理生理过程。
(中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校)
(J Allergy Clin Immunol. 2021 Aug 23;S0091-6749(21)01302-6. doi: 10.1016/j.jaci.2021.07.042.)
(J Allergy Clin Immunol. 2021 Aug 23;S0091-6749(21)01302-6. doi: 10.1016/j.jaci.2021.07.042.)
Parenchymal destruction in asthma: Fixed airflow obstruction and lung function trajectory
Kaoruko Shimizu, Naoya Tanabe, Akira Oguma, Hirokazu Kimura, Masaru Suzuki, Isao Yokota, Hironi Makita, Susumu Sato, Toyohiro Hirai, Masaharu Nishimura, Satoshi Konno, Hi-CARAT investigators
Abstract
Background: Fixed airflow obstruction (FAO) in asthma, particularly in non-smoking subjects, is generally believed to be caused by airway remodeling. However, parenchymal destruction may also contribute to FAO and longitudinal decline in forced expiratory volume in 1 sec (FEV1).
Objectives: To evaluate parenchymal destruction using emphysema indices, exponent D and low attenuation area percent (LAA%) on computed tomography (CT), and test whether the parenchymal destruction and airway disease are independently associated with FAO and FEV1 decline in both smoking and non-smoking asthma.
Methods: D, LAA%, wall area percent (WA%) at segmental airways, and airway fractal dimension (AFD) in asthmatics were measured on inspiratory CT and compared to those in chronic obstructive pulmonary disease (COPD) patients.
Results: D was lower and LAA% was higher in COPD (N = 42) and asthma with FAO (N = 101) than in asthma without FAO (N = 88). The decreased D and increased LAA% were associated with FAO regardless of smoking status or asthma severity. In multivariable analysis, decreased D and increased LAA% were associated with an increased odds ratio of FAO and decreased FEV1, irrespective of WA% and AFD. Moreover, decreased D affected the longitudinal decline in FEV1 in severe asthmatics, independent of smoking status.
Conclusions: Asthmatics with FAO showed the parenchymal destruction regardless of smoking status and asthma severity. The parenchymal destruction was associated with an accelerated FEV1 decline, suggesting the involvements of both airway and parenchyma in the pathophysiology of a subgroup of asthma.
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microRNA-155对异氰酸酯诱发的哮喘中固有淋巴细胞的作用
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