哮喘患者接受抗炎平喘治疗后仍存在气流受限、气道狭窄
2009/03/16
美国University of Virginia Health Sciences Center 放射科Eduard E. de Lange教授研究小组，应用超极化（hyperpolarized）氦3（3 helium）气体吸入磁共振技术，研究了抗炎平喘治疗过程中，哮喘患者气道阻塞和气流受限的动态变化。对43例哮喘患者，逐日进行了肺功能、哮喘严重程度评估及平喘药物处方情况登记，同时进行了共103次动态磁共振影像检查。研究发现患者气流受限、气道狭窄并未随平喘治疗（中位数疗程，85日）而改善。
研究结果显示哮喘患者的局部气流受限可持续存在，与哮喘严重程度及是否接受平喘治疗不平行。
（蔡闯 广州医学院第一附属医院 广州呼吸疾病研究所 510120 摘译）
（Radiology. 2009;250(2):567-575）
Changes in Regional Airflow Obstruction over Time in the Lungs of Patients with Asthma: Evaluation with 3He MR Imaging.
de Lange EE, Altes TA, Patrie JT, Battiston JJ, Juersivich AP, Mugler JP 3rd, Platts-Mills TA.
PURPOSE: To determine changes in regional airflow obstruction over time in the lungs of patients with asthma, as demonstrated with hyperpolarized helium 3 ((3)He) magnetic resonance (MR) imaging, and to assess correlations with disease severity and use of asthma medications.
MATERIALS AND METHODS: Institutional review board approval and written informed consent were obtained for this HIPAA-compliant study. Use of (3)He was approved by the U.S. Food and Drug Administration. Forty-three patients underwent 103 MR imaging studies in total; 26 were imaged twice within 42-82 minutes (same day), and 17 were imaged on 3 days between 1 and 476 days (multiday). Each day, spirometry was performed, disease severity was determined, and the use of asthma medications was recorded. Images were reviewed in a pairwise fashion to determine total ventilation defect number, defects in same location between imaging studies, and size. Parametric and nonparametric statistical methods were used.
RESULTS: For the same-day examinations, the mean number of defects per image section was similar at baseline and repeat imaging (1.8 +/- 1.9 [standard deviation] vs 1.6 +/- 1.9, respectively; P = .15), with 75% of defects remaining in the same location and 71% of these not changing size. For the multiday examinations, the mean number of defects per section was higher for study 2 (2.4 +/- 1.5) than study 1 (1.7 +/- 0.9, P = .02), was lower for study 3 (1.5 +/- 1.1) than for study 2 (P < .01), and was similar for studies 1 and 3 (P = .56). Time between examinations was not associated with change in mean number of defects per section (median intrasubject correlation [r(m)] = 0.01, P = .64) or change in spirometric values (range of r(m) values: -0.56 to -0.31; range of P values: .09-.71). Defects in the same location decreased with time (r(m) = -0.83, P < .01), with 67% persisting between studies 1 and 2 (median interval, 31 days), 43% persisting between studies 2 and 3 (median interval, 41 days), and 38% persisting between studies 1 and 3 (median interval, 85 days); 46%-58% of defects remained unchanged in size. These trends were the same regardless of disease severity or medication use.
CONCLUSION: In asthma, focal airflow impediment within the lungs can be markedly persistent over time, regardless of disease severity or treatment.
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过敏性鼻炎血清嗜酸性粒细胞蛋白能够预测哮喘风险
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