多层螺旋CT对慢阻肺及哮喘-慢阻肺重叠综合征的定量研究
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摘要
目的:探讨慢性阻塞性肺疾病(COPD)与哮喘-慢阻肺重叠综合征(ACOS)气道重构的差异。方法:COPD患者45例,平均年龄(65.6±7.9)岁,ACOS患者40例,平均年龄(68.0±6.7)岁,分别行螺旋CT及肺功能检查,测量右肺上叶尖段气道横截面总面积At和管腔横截面积Al,计算管壁面积WA、管壁面积占气道总面积的百分比(WA%)及管壁厚度(WT),比较COPD与ACOS气道指标、肺功能差异,分析气管舒张药反应性(BDR)与气道指标(WA%、WT)及肺功能(FEV1%、FEV1/FVC)的相关性。结果:ACOS组WT(1.72±0.66)mm,大于COPD组的(1.69±0.69)mm(P<0.05)。ACOS组WA%为(78.88±5.01)大于COPD组的(76.46±4.72)(P <0.05)。ACOS组与COPD组肺功能差异无统计学意义(P>0.05)。BDR与WT、WA%正相关(r=0.365、0.407,P<0.05),与FEV1%、FEV1/FVC及年龄无关(r=-0.167、0.148、0.133,P>0.05)。结论:ACOS与COPD患者气道重构模式不同,不同的重构模式反映ACOS和COPD病理进程的差异。
Objective: To evaluate the difference of airwaywall remodeling between COPD and ACOS. Methods: 45 COPD patients which averge age is(65.6±7.9) and 40 ACOS patients which averge age is(68.0±6.7) performed with MSCT and PFT. The areas of apical segmental bronchi of the right upper lobe were measured, including indicators such as total airway cross sectional area(At), airway luminal area(Al) and calculate airway wall area(WA), the percentage of airway wall area to total airway cross sectional area(WA%) and airway wall thickness(WT). The differences of those indicators and PFT in COPD and ACOS subjects were compared. The correlation between bronchodilator responsiveness(BDR) and airway indicators(WA%,WT), and PFTC(FEV1%, FEV1/FVC) were analyzed. Results: The WT of ACOS group is(1.72±0.66) mm and higher than that in COPD group at(1.69±0.69) mm(P<0.05). The WA% of ACOS group is(78.88±5.01), and higher than that in COPD group at(76.46±4.72)(P<0.05). PFT had no difference between ACOS group and COPD group(P >0.05). BDR was related to WT and WA%(r = 0.365、0.407,P <0.05). The correation had no significance between BDR and FEV1, FEV1/FVC and age(r =-0.167, 0.148, 0.133, P >0.05). Conlution: The remodeling of airway in ACOS and COPD subjects is heterogeneous and the different pattern of remodeling reflect differences in the pathological processes in ACOS and COPD.
Objective: To evaluate the difference of airwaywall remodeling between COPD and ACOS. Methods: 45 COPD patients which averge age is(65.6±7.9) and 40 ACOS patients which averge age is(68.0±6.7) performed with MSCT and PFT. The areas of apical segmental bronchi of the right upper lobe were measured, including indicators such as total airway cross sectional area(At), airway luminal area(Al) and calculate airway wall area(WA), the percentage of airway wall area to total airway cross sectional area(WA%) and airway wall thickness(WT). The differences of those indicators and PFT in COPD and ACOS subjects were compared. The correlation between bronchodilator responsiveness(BDR) and airway indicators(WA%,WT), and PFTC(FEV1%, FEV1/FVC) were analyzed. Results: The WT of ACOS group is(1.72±0.66) mm and higher than that in COPD group at(1.69±0.69) mm(P<0.05). The WA% of ACOS group is(78.88±5.01), and higher than that in COPD group at(76.46±4.72)(P<0.05). PFT had no difference between ACOS group and COPD group(P >0.05). BDR was related to WT and WA%(r = 0.365、0.407,P <0.05). The correation had no significance between BDR and FEV1, FEV1/FVC and age(r =-0.167, 0.148, 0.133, P >0.05). Conlution: The remodeling of airway in ACOS and COPD subjects is heterogeneous and the different pattern of remodeling reflect differences in the pathological processes in ACOS and COPD.
引文
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[11]路明,姚婉贞.支气管哮喘-慢性阻塞性肺疾病重叠综合征研究进展[J].中国实用内科杂志,2015,35(5):379-381.
[12]Rennard SI.Chronic obstructive pulmonary disease:linking outcomes and pathobiology of disease modification[J].Proc Am Thorac Soc,2006,3(3):276-280.
[13]Cho MH,Washko GR,Hof fmann TJ,et al.Cluster analysis in severe emphysema sub jects using phenotype and genotype data:an exploratory investigation[J].Respir Res,2010,16(11):658-676.
[14]Battaglia S,Mauad T,van Schadewijk AM,et al.Differential distribution of inflammatory cells in large and small airways in smokers[J].Clin Pathol,2007,60(8):907-911.
[15]Kim V,Pechulis RM,AbuelHaija M,et al.Small Airway Pathology and Bronchoreversibility in Advanced Emphysema[J].COPD,2010,7(15):93-101.
[16]Kim MA,Noh CS,Chang YJ,et al.Asthma and COPD overlap syndrome is associated with increased risk of hospitalisation[J].Int J Chron Obstruct Pulmon Dis,2015,19(7):864-869.
[17]Kim V,Desai P,Newell JD,et al.Airway wall thickness is increased in COPD patients with bronchodilator responsiveness[J].Respiratory Research,2014,15(34):84-105.
[2]何薇,宋康,陈芳.肺功能在诊断支气管哮喘合并慢性阻塞性肺疾病中的应用[J].中华哮喘杂志(电子版),2013,7(4):30-33.
[3]Asthma,COPD and Asthma-COPDOverlap Syndrome(ACOS)[R/OL].Global initiative for Asthma(GINA),2014.http://www.ginasthma.org.
[4]KUR ASHIMA K,TAKAKU Y,OHTAC,et al.COPD assessmenttest and severity of airflow limitation in patients with asthma,COPD,and asthma-COPD overlap syndrome[J].Int J Chron Obstruct Pulmon Dis,2016,1:479-487.
[5]孙永昌.哮喘-慢阻肺重叠综合征指南解读[J].中国呼吸与危重监护杂志,2014,13(4):325-329.
[6]房宾,武志峰.慢性阻塞性肺疾病患者支气管壁厚度与肺功能的相关性[J].中国医学影像技术,2011,27(4):751-755.
[7]周洁,刘斯润,曾庆思,等.低剂量HRCT对COPD患者小气道的定量研究[J].临床放射学杂志,2017,36(1):55-59.
[8]Soler-Cataluna JJ,Cosio B,Izquierdo JL,et al.Consensus document on the overlap plienotype COPD-astlima in COPD[J].Arch Bronconeumol,2012,48(9):331-337.
[9]Tashkin DP,Celli B,Decramer M,et al.Bronchodilator responsiveness in patients with COPD[J].Eur Respir.2008,31(7):742-750.
[10]Gibson PG,Simpson JL.The overlap syndrome of asthma and COPD:what are its features and how important is it?Thorax[J].2009,64(8):728-735.
[11]路明,姚婉贞.支气管哮喘-慢性阻塞性肺疾病重叠综合征研究进展[J].中国实用内科杂志,2015,35(5):379-381.
[12]Rennard SI.Chronic obstructive pulmonary disease:linking outcomes and pathobiology of disease modification[J].Proc Am Thorac Soc,2006,3(3):276-280.
[13]Cho MH,Washko GR,Hof fmann TJ,et al.Cluster analysis in severe emphysema sub jects using phenotype and genotype data:an exploratory investigation[J].Respir Res,2010,16(11):658-676.
[14]Battaglia S,Mauad T,van Schadewijk AM,et al.Differential distribution of inflammatory cells in large and small airways in smokers[J].Clin Pathol,2007,60(8):907-911.
[15]Kim V,Pechulis RM,AbuelHaija M,et al.Small Airway Pathology and Bronchoreversibility in Advanced Emphysema[J].COPD,2010,7(15):93-101.
[16]Kim MA,Noh CS,Chang YJ,et al.Asthma and COPD overlap syndrome is associated with increased risk of hospitalisation[J].Int J Chron Obstruct Pulmon Dis,2015,19(7):864-869.
[17]Kim V,Desai P,Newell JD,et al.Airway wall thickness is increased in COPD patients with bronchodilator responsiveness[J].Respiratory Research,2014,15(34):84-105.
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