咳嗽变异性哮喘和非哮喘慢性咳嗽患者中的气道壁增厚
2007/06/27
慢性咳嗽是哮喘的一种表现，也可以由非哮喘因素引起，他是临床上的常见表现之一。气道炎症，表现为基底膜增厚的气道重构现象均在咳嗽变异性哮喘（CVA）和非哮喘性慢性咳嗽（NAC）中较为常见。由于CT影像学研究可发现喘息症状存在的哮喘患者的气道壁增厚，就可以通过这种方法来比较慢性咳嗽患者的气道情况和病理生理对其产生的影响。
Hisako Matsumoto等就是通过这种方法进行如下研究：研究对象为非吸烟未使用过糖皮质激素的CVA患者(n = 27)和NAC患者 (n = 26)以及健康对照组(n=15)。气道的舒张程度由CT技术测定，通过测定气道壁面积（WA）经体表面积（BSA）的矫正值，WA与外壁区域的比值（壁面积比例[WA%]，绝对壁厚度（T）/BSA和段支气管气道腔内面积/BSA。同时分析了CT所测定的参数和临床指标如疾病时间和咳嗽程度等之间的关系。
研究结果发现，在CVA患者中，WA/BSA, WA%, 和 T/BSA较正常人均显著增大，而在NAC患者，WA/BSA和T/ BSA也较正常人大，但WA/BSA和T/ BSA的增幅比例低于CVA患者。而且，在NAC患者的一群亚组病例中，WA%与辣椒素咳嗽的敏感性相关(n=9, r=0.75, p=0.034)。因此，本项研究可以给我们这样的提示：中央气道的气道壁在CVA患者中是增厚的，NAC患者虽然也有这样的情况但程度要低一些。NAC的气道壁增厚可能与咳嗽的敏感性相关。
（汤葳 上海瑞金医院呼吸科 200025 摘译）
(Chest. 2007;131:1042-1049)
Airway Wall Thickening in Patients With Cough Variant Asthma and Nonasthmatic Chronic Cough*
Hisako Matsumoto, MD, PhD; Akio Niimi, MD, PhD; Rollin P.Tabuena, MD; Masaya Takemura, MD; Tetsuya Ueda, MD; Masafumi Yamaguchi, MD; Hirofumi Matsuoka, MD; Makiko Jinnai, MD; Kazuo Chin, MD, PhD and Michiaki Mishima, MD, PhD
* From the Departments of Respiratory Medicine (Drs. Matsumoto, Niimi, Takemura, Ueda, Yamaguchi, Matsuoka, Jinnai, Chin, and Mishima), Kyoto University, Kyoto, Japan; and Iloilo Mission Hospital (Dr. Tabuena), Department of Internal Medicine, Iloilo City, Philippines.
Correspondence to: Hisako Matsumoto, MD, PhD, Department of Respiratory Medicine, Kyoto University, Sakyo-ku, Kyoto, 606-8507, Japan; e-mail: hmatsumo@kuhp.kyoto-u.ac.jp Abstract
Background: Chronic cough, which may be of asthmatic or nonasthmatic origin, is an important clinical issue. Airway inflammation, and remodeling demonstrated by subbasement membrane thickening has been associated with cough variant asthma (CVA) as well as with nonasthmatic chronic cough (NAC). CT studies have shown airway wall thickening in patients with asthma who wheeze. We examined airway wall thickness by CT in adult patients with chronic cough and examined its pathophysiologic implication.
Methods: Nonsmoking, steroid-na?ve patients with CVA (n=27), NAC (n=26), and healthy control subjects (n=15) were studied. Airway dimensions were assessed by a validated CT technique, in which we measured airway wall area (WA) corrected by body surface area (BSA), the ratio of WA to outer wall area (percentage of wall area [WA%]), absolute wall thickness (T)/ BSA, and airway luminal area/BSA of a segmental bronchus. Correlations between CT parameters and clinical indexes such as disease duration and cough sensitivity were examined.
Results: In patients with CVA, WA/BSA, WA%, and T/ BSA were all significantly greater than those in control subjects. In patients with NAC, WA/BSA and T/ BSA were significantly greater than in control subjects. The increase of WA/BSA and T/ BSA of NAC patients was less than that of CVA patients. In a subset of patients with NAC, WA% correlated with capsaicin cough sensitivity (n=9, r=0.75, p=0.034).
Conclusions: Walls of central airways are thickened in patients with CVA, and also to a lesser degree in patients with NAC. Airway wall thickening in NAC may be associated with cough hypersensitivity.
Key Words: airway wall thickening·cough sensitivity·cough variant asthma·CT·nonasthmatic chronic cough
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咳嗽变异性哮喘和非哮喘慢性咳嗽同样存在气道壁增厚
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