Verbanck S, Schuermans D, Noppen M, Van Muylem A, Paiva M, Vincken W
Respiratory Division, Academic Hospital, Vrije Universiteit Brussel, Brussels; Respiratory Division, Academic Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
Am J Respir Crit Care Med. 1999 May;159(5 Pt 1):1545-50. doi: 10.1164/ajrccm.159.5.9809017.
We investigated acinar airway involvement in 20 patients with stable asthma, using the phase III slope analysis of the multiple breath N2 washout previously applied in a group of patients with COPD (Am. J. Respir. Crit. Care Med. 1998;157:1573-1577). This technique quantifies severity of conductive and acinar components of ventilation maldistribution separately, through indices S(cond) and S(acin), which increase when respective ventilation inhomogeneities increase. We also investigated the effect of salbutamol inhalation on S(cond) and S(acin) in patients with asthma and compared it with that obtained in patients with COPD. Baseline measurements in the patients with asthma show that (1) acinar ventilation inhomogeneity was indeed abnormal in patients with asthma (S(acin) = 0.195 +/- 0.026 L-1) despite the normal diffusing capacity in this group; S(acin) values were intermediate between those obtained in unaffected individuals and patients with COPD, and that (2) conductive ventilation inhomogeneity was abnormal in the patients with asthma (S(cond) = 0.076 +/- 0.006 L-1) but similar to that obtained in the patients with COPD. Measurements after salbutamol inhalations showed significant changes in S(cond) and S(acin) only in the patients with asthma (p < 0.001). This study primarily demonstrated significant, but partially reversible, acinar airway impairment in patients with asthma, as compared with the more severe baseline acinar airway impairment in patients with COPD, which was not reversible after salbutamol inhalation.
我们采用先前应用于一组慢性阻塞性肺疾病（COPD）患者的多次呼吸氮洗脱三期斜率分析方法，对20例稳定期哮喘患者的腺泡气道受累情况进行了研究（《美国呼吸与危重症医学杂志》1998年；157:1573 - 1577）。该技术通过指数S(cond)和S(acin)分别量化通气分布不均的传导性和腺泡成分的严重程度，当各自的通气不均匀性增加时，这些指数会升高。我们还研究了沙丁胺醇吸入对哮喘患者S(cond)和S(acin)的影响，并将其与COPD患者的情况进行比较。哮喘患者的基线测量结果显示：（1）尽管该组患者的弥散能力正常，但哮喘患者的腺泡通气不均匀性确实异常（S(acin) = 0.195 ± 0.026 L-1）；S(acin)值介于未受影响个体和COPD患者之间；（2）哮喘患者的传导性通气不均匀性异常（S(cond) = 0.076 ± 0.006 L-1），但与COPD患者相似。吸入沙丁胺醇后的测量结果显示，仅哮喘患者的S(cond)和S(acin)有显著变化（p < 0.001）。本研究主要表明，与COPD患者更严重的基线腺泡气道损伤相比，哮喘患者存在显著但部分可逆的腺泡气道损伤，COPD患者吸入沙丁胺醇后损伤不可逆。
