月经周期对哮喘妇女肺功能参数的影响
2009/08/11
基础理论：血管形成是气道重构的明确病理特征之一，与哮喘的严重程度相关。女性在月经周期中也经历了从血管形成到衰退的整个过程，此过程受到血管生长因子的调节，因此在月经周期内哮喘控制情况也会随之改变。健康女性在月经周期内受调节的一项生命功能，气体转运，已发现其与血管形成及肺血管床的周期性扩展有关。
目的：我们认为，哮喘妇女在月经周期内会出现气体转运和肺血管床的改变，而且与气流阻塞加重有关。
方法：23名女性（13名哮喘患者和10名健康志愿者）入选本研究。月经周期内每周检查肺活量、气体转运、一氧化氮、血红蛋白、影响血红蛋白结合的因子以及促血管形成因子等。
检测结果：月经周期内的气流和气体弥散能力不尽相同，月经期达到峰值，随后下降，至黄体早期降至最低。与健康女性不同的是，肺内气体弥散能力（DLCO）的变化与膜弥散能力的改变有关，而与促血管生成因子无关。虽然氧化血红蛋白和碳氧血红蛋白的含量在哮喘患者较高，但两者的DLCO无显著差异。
结论：哮喘患者在月经周期内出现了气流、气体转运及膜弥散能力的周期性改变，这个现象是激素对肺功能有影响的一个支持观点。
（苏楠 审校）
Farha S, et al.Am J Respir Crit Care Med. 2009 Jun 11. [Epub ahead of print]
Effects of the Menstrual Cycle on Lung Function Variables in Women with Asthma.
Farha S, Asosingh K, Laskowski D, Hammel J, Dweik RA, Wiedemann HP, Erzurum SC.
Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, United States.
RATIONALE: Angiogenesis is a defining pathologic feature of airway remodeling and contributes to asthma severity. Women experience changes in asthma control over the menstrual cycle, a time when vessels routinely form and regress under the control of angiogenic factors. One vital function modulated over the menstrual cycle in healthy women is gas transfer, and this has been related to angiogenesis and cyclic expansion of the pulmonary vascular bed.
OBJECTIVES: We hypothesized that changes in gas transfer and the pulmonary vascular bed occur in asthmatic women over the menstrual cycle and are associated with worsening airflow obstruction.
METHODS: Twenty three women, thirteen asthmatics and ten healthy controls were evaluated over the menstrual cycle with weekly measures of spirometry, gas transfer, nitric oxide, hemoglobin, factors affecting hemoglobin binding affinity, and pro-angiogenic factors.
Measurements and RESULTS: Airflow and lung diffusing capacity varied over the menstrual cycle with peak levels during menses that subsequently declined to nadir in early luteal phase. In contrast to healthy women, changes in lung diffusing capacity (DLCO) were associated with changes in membrane diffusing capacity and DLCO was not related to pro-angiogenic factors. DLCO was not different between the two groups, though methemoglobin and carboxyhemoglobin were higher in asthmatics than healthy women.
CONCLUSION: Asthmatic women experience cyclic changes in airflow as well as gas transfer and membrane diffusing capacity supportive of a hormonal effect on lung function.
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