月经周期影响女性哮喘患者肺功能
2010/01/07
血管增生是哮喘气道重建一个重要的病理特征，并与哮喘严重度相关。对女性哮喘患者而言，月经周期中，在血管生长因子的作用下血管周期性的形成和消退会影响哮喘的控制。对健康女性来说，月经周期的一个重要作用是血管生长因子作用下周期性的肺血管床的膨胀影响了气体交换。因此该研究中Farha S等提出女性哮喘患者随月经周期出现的肺血管床和气体交换的变化与气流阻塞加重相关。该研究入选了23例育龄期女性，其中13例哮喘患者，10例健康对照者。月经周期中每周评估肺功能、气体交换能力、NO水平、血红蛋白水平，影响血红蛋白结合的因素、促血管增生的因素。
结果：气流阻塞和肺气体弥散能力在月经周期的不同阶段是不同的，在月经期间达峰值，而在黄体期降至最低水平。对健康对照者而言，CO弥散率（DL(CO)）的变化和膜的弥散能力相关，但和促血管生成因素无关。哮喘组和健康对照组的DL(CO)无明显差异，但前者的高铁血红蛋白水平和碳氧血红蛋白水平高于后者。
因此，作者认为，女性哮喘患者会随月经周期出现相应气流阻力和气体弥散和交换能力的变化，支持激素影响肺功能的观点。
（王苹莉 浙江医科大学附属第二医院呼吸科 310009 摘译）
Am J Respir Crit Care Med. 2009 Aug 15;180(4):304-310.
Farha S, Asosingh K, Laskowski D, Hammel J, Dweik RA, Wiedemann HP, Erzurum SCEffects of the menstrual cycle on lung function variables in women with asthma.
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 women with asthma over the menstrual cycle and are associated with worsening airflow obstruction.
METHODS: Twenty-three women, 13 with asthma and 10 healthy control subjects, were evaluated over the menstrual cycle with weekly measures of spirometry, gas transfer, nitric oxide, hemoglobin, factors affecting hemoglobin binding affinity, and proangiogenic factors.
MEASUREMENTS AND MAIN 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 (DL(CO)) were associated with changes in membrane diffusing capacity and DL(CO) was not related to proangiogenic factors. DL(CO) did not differ between the two groups, although methemoglobin and carboxyhemoglobin were higher in women with asthma than in healthy women.
CONCLUSIONS: Women with asthma experience cyclic changes in airflow as well as gas transfer and membrane diffusing capacity supportive of a hormonal effect on lung function.
Am J Respir Crit Care Med. 2009 Aug 15;180(4):304-10.
结果：气流阻塞和肺气体弥散能力在月经周期的不同阶段是不同的，在月经期间达峰值，而在黄体期降至最低水平。对健康对照者而言，CO弥散率（DL(CO)）的变化和膜的弥散能力相关，但和促血管生成因素无关。哮喘组和健康对照组的DL(CO)无明显差异，但前者的高铁血红蛋白水平和碳氧血红蛋白水平高于后者。
因此，作者认为，女性哮喘患者会随月经周期出现相应气流阻力和气体弥散和交换能力的变化，支持激素影响肺功能的观点。
（王苹莉 浙江医科大学附属第二医院呼吸科 310009 摘译）
Am J Respir Crit Care Med. 2009 Aug 15;180(4):304-310.
Farha S, Asosingh K, Laskowski D, Hammel J, Dweik RA, Wiedemann HP, Erzurum SCEffects of the menstrual cycle on lung function variables in women with asthma.
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 women with asthma over the menstrual cycle and are associated with worsening airflow obstruction.
METHODS: Twenty-three women, 13 with asthma and 10 healthy control subjects, were evaluated over the menstrual cycle with weekly measures of spirometry, gas transfer, nitric oxide, hemoglobin, factors affecting hemoglobin binding affinity, and proangiogenic factors.
MEASUREMENTS AND MAIN 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 (DL(CO)) were associated with changes in membrane diffusing capacity and DL(CO) was not related to proangiogenic factors. DL(CO) did not differ between the two groups, although methemoglobin and carboxyhemoglobin were higher in women with asthma than in healthy women.
CONCLUSIONS: Women with asthma experience cyclic changes in airflow as well as gas transfer and membrane diffusing capacity supportive of a hormonal effect on lung function.
Am J Respir Crit Care Med. 2009 Aug 15;180(4):304-10.
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