咳嗽变异性哮喘和非哮喘慢性咳嗽同样存在气道壁增厚
2007/10/26
《Chest》中文章：慢性咳嗽，无论是哮喘因素或者非哮喘因素引起，是目前临床面临的重要问题。咳嗽变异性哮喘（CVA）或者非哮喘因素引起的慢性咳嗽（NAC），都可能存在因气道炎症、气道重塑造成的基底膜增厚。研究对27名CVA患者，26名NAC患者及15名健康人经胸部CT进行了WA、BSA、WA%、T/BSA-2的测定。结果发现CVA患者的WA、BSA、WA%、T/BSA-2要高于健康人，NAC患者的上述数值也高于健康人。CVA患者与NAC患者相比，前者也高于后者。
结论：CVA患者存在中心气道壁增厚， NAC患者气道壁增厚的程度稍轻一些。NAC患者气道反应性升高也与气道壁增厚有关。
METHODS: Nonsmoking, steroid-naive 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)/ square root 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/ square root BSA were all significantly greater than those in control subjects. In patients with NAC, WA/BSA and T/ square root BSA were significantly greater than in control subjects. The increase of WA/BSA and T/ square root 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.
结论：CVA患者存在中心气道壁增厚， NAC患者气道壁增厚的程度稍轻一些。NAC患者气道反应性升高也与气道壁增厚有关。
(杨萌 卫生部中日友好医院呼吸科 100029 摘译)
(Chest 2007：131:1042-1049)
Matsumoto H, Niimi A, Tabuena RP, et al. Airway wall thickening in patients with cough variant asthma and nonasthmatic chronic cough. Chest JT - Chest, 2007,131(4):1042-9
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-naive 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)/ square root 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/ square root BSA were all significantly greater than those in control subjects. In patients with NAC, WA/BSA and T/ square root BSA were significantly greater than in control subjects. The increase of WA/BSA and T/ square root 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.
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慢性咳嗽的发病率、发病机制及病因
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咳嗽变异性哮喘和非哮喘慢性咳嗽患者中的气道壁增厚
