难治性哮喘患者声带功能异常
2011/06/17
摘要
原理：上气道功能异常可使哮喘更为复杂化，但上气道功能异常作为哮喘的病因之一常常被忽略。由于临床应用受限，采用内镜评价声带功能来进行诊断较为困难。
目的：采用新的影像学技术（动态320层CT）检测健康对照和哮喘患者的喉部运动功能。
方法与检测指标：采用320层喉部CT扫描对声带运动进行拍片。同时对正常志愿者的喉部运动拍片后进行分析和证实，对正常声带功能进行定量分析。随后，在46名难治性哮喘患者中进行进一步研究。
主要结果：计算声带直径与气管直径的比值，并采用该比值，在呼吸周期中运用CT对声带运动进行量化。计算正常值范围并进行证实，并用于评价难治性哮喘患者声带运动。46名哮喘患者中，有23名（50%）声带运动异常（过分狭窄），9名患者(19%)严重异常（>50%的吸气或呼气时间存在异常）。影像检查同时发现，喉部功能异常以喉运动异常为特征，而不是孤立的声带异常。
结论：可采用喉部CT扫描进行无创性喉部运动定量分析。难治性哮喘患者相当一部分存在声带的过分狭窄。这种新方法发现，哮喘患者的上气道功能异常较常见，这可能与疾病的控制和治疗有一定联系。
（刘国梁 审校）
Am J Respir Crit Care Med. 2011 Mar 31. [Epub ahead of print]
Abnormal Vocal Cord Function in Difficult-to-Treat Asthma.
Low K, Lau KK, Holmes P, Crossett M, Vallance N, Phyland D, Hamza K, Hamilton G, Bardin PG.
Respiratory and Sleep Medicine, Monash University and Medical Centre, Melbourne, Victoria, Australia.
Abstract
RATIONALE: Upper airway dysfunction may complicate asthma, but has been largely ignored as an etiological factor. Diagnosis using endoscopic evaluation of vocal cord function is difficult to quantify with limited clinical application.
OBJECTIVES: A novel imaging technique, dynamic 320-slice computerised tomography (CT), was used to examine laryngeal behaviour in healthy and asthmatic individuals.
METHODS AND MEASUREMENTS: Vocal cord movement was imaged using 320-slice CT larynx. Healthy volunteers were studied to develop and validate an analysis algorithm for quantification of normal vocal cord function. Further studies were then conducted in 46 patients with difficult-to-treat asthma.
MAIN RESULTS: Vocal cord movement was quantified over the breathing cycle by CT using the ratio of vocal cord diameter to tracheal diameter. Normal limits were calculated, validated and applied to evaluate difficult-to-treat asthma. Vocal cord movement was abnormal with excessive narrowing in 23 of 46 (50%) asthmatics and severe in nine (19%) patients (abnormal >50% of inspiration or expiration time). Imaging also revealed that laryngeal dysfunction characterised the movement abnormality, rather than isolated vocal cord abnormality. CONCLUSIONS: Non-invasive CT larynx quantification of laryngeal movement was achieved employing CT larynx. Significant numbers of patients with difficult-to-treat asthma had excessive narrowing of the vocal cords. This new approach has identified frequent upper airway dysfunction in asthma with potential implications for disease control and treatment.
Am J Respir Crit Care Med. 2011 Mar 31. [Epub ahead of print]
原理：上气道功能异常可使哮喘更为复杂化，但上气道功能异常作为哮喘的病因之一常常被忽略。由于临床应用受限，采用内镜评价声带功能来进行诊断较为困难。
目的：采用新的影像学技术（动态320层CT）检测健康对照和哮喘患者的喉部运动功能。
方法与检测指标：采用320层喉部CT扫描对声带运动进行拍片。同时对正常志愿者的喉部运动拍片后进行分析和证实，对正常声带功能进行定量分析。随后，在46名难治性哮喘患者中进行进一步研究。
主要结果：计算声带直径与气管直径的比值，并采用该比值，在呼吸周期中运用CT对声带运动进行量化。计算正常值范围并进行证实，并用于评价难治性哮喘患者声带运动。46名哮喘患者中，有23名（50%）声带运动异常（过分狭窄），9名患者(19%)严重异常（>50%的吸气或呼气时间存在异常）。影像检查同时发现，喉部功能异常以喉运动异常为特征，而不是孤立的声带异常。
结论：可采用喉部CT扫描进行无创性喉部运动定量分析。难治性哮喘患者相当一部分存在声带的过分狭窄。这种新方法发现，哮喘患者的上气道功能异常较常见，这可能与疾病的控制和治疗有一定联系。
（刘国梁 审校）
Am J Respir Crit Care Med. 2011 Mar 31. [Epub ahead of print]
Abnormal Vocal Cord Function in Difficult-to-Treat Asthma.
Low K, Lau KK, Holmes P, Crossett M, Vallance N, Phyland D, Hamza K, Hamilton G, Bardin PG.
Respiratory and Sleep Medicine, Monash University and Medical Centre, Melbourne, Victoria, Australia.
Abstract
RATIONALE: Upper airway dysfunction may complicate asthma, but has been largely ignored as an etiological factor. Diagnosis using endoscopic evaluation of vocal cord function is difficult to quantify with limited clinical application.
OBJECTIVES: A novel imaging technique, dynamic 320-slice computerised tomography (CT), was used to examine laryngeal behaviour in healthy and asthmatic individuals.
METHODS AND MEASUREMENTS: Vocal cord movement was imaged using 320-slice CT larynx. Healthy volunteers were studied to develop and validate an analysis algorithm for quantification of normal vocal cord function. Further studies were then conducted in 46 patients with difficult-to-treat asthma.
MAIN RESULTS: Vocal cord movement was quantified over the breathing cycle by CT using the ratio of vocal cord diameter to tracheal diameter. Normal limits were calculated, validated and applied to evaluate difficult-to-treat asthma. Vocal cord movement was abnormal with excessive narrowing in 23 of 46 (50%) asthmatics and severe in nine (19%) patients (abnormal >50% of inspiration or expiration time). Imaging also revealed that laryngeal dysfunction characterised the movement abnormality, rather than isolated vocal cord abnormality. CONCLUSIONS: Non-invasive CT larynx quantification of laryngeal movement was achieved employing CT larynx. Significant numbers of patients with difficult-to-treat asthma had excessive narrowing of the vocal cords. This new approach has identified frequent upper airway dysfunction in asthma with potential implications for disease control and treatment.
Am J Respir Crit Care Med. 2011 Mar 31. [Epub ahead of print]
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哮喘和慢性阻塞性肺疾病新的诊断性生物标志物
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