Takemura Masaya, Niimi Akio, Minakuchi Masayoshi, Matsumoto Hisako, Ueda Tetsuya, Chin Kazuo, Mishima Michiaki
Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Japan.
Chest. 2004 Apr;125(4):1352-8. doi: 10.1378/chest.125.4.1352.
Investigations using high-resolution CT (HRCT) show that bronchial dilatation (BD) is found in many patients with asthma. However, the pathogenesis and pathophysiologic relevance of BD in asthma are poorly understood. A balance between matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) may control the remodeling of extracellular matrix, and excess MMPs have been associated with destruction or dilatation of airways in patients with bronchiectasis.
To study the prevalence of BD as assessed by HRCT according to standard subjective criteria in 37 patients with stable asthma and 10 healthy control subjects, and to examine the relation of BD in asthmatic patients to clinical characteristics and sputum indices, including MMP-9 and TIMP-1 levels.
A prospective cohort study.
At least one dilated bronchus was present in 23 asthmatic subjects (62%) and 2 control subjects (20%) [p = 0.030]. The ratio of dilated bronchi to all eligible bronchi in each subject (individual BD%) was higher in the asthmatic patients than in the control subjects (11.4 +/- 16.1% vs 1.3 +/- 3.0%, p = 0.011) [mean +/- SD]. Asthmatic patients with (n = 23) and those without BD (n = 14) were similar with regard to age, duration and severity of asthma, atopy, pulmonary function, sputum eosinophil or neutrophil count, and sputum levels of MMP-9 or TIMP-1 and their molar ratio. Individual BD% of asthmatic patients was also unrelated to these clinical and sputum variables. When analysis was confined to the 23 patients with BD, however, individual BD% correlated with the severity score of asthma (r = 0.49, p = 0.023). The results of follow-up HRCT obtained from 19 patients suggested that BD was a fixed rather than transient phenomenon.
BD is more prevalent in asthmatic patients than in normal subjects and might be associated with the severity of asthma. Cellular inflammation or possible imbalance between MMP-9 and TIMP-1 was not demonstrated in this study to be related to BD in asthma.
使用高分辨率CT（HRCT）进行的研究表明，许多哮喘患者存在支气管扩张（BD）。然而，哮喘中BD的发病机制和病理生理相关性仍知之甚少。基质金属蛋白酶（MMPs）与金属蛋白酶组织抑制剂（TIMPs）之间的平衡可能控制细胞外基质的重塑，并且MMPs过多与支气管扩张症患者气道的破坏或扩张有关。
根据标准主观标准，通过HRCT研究37例稳定期哮喘患者和10例健康对照者中BD的患病率，并研究哮喘患者中BD与临床特征及痰液指标（包括MMP-9和TIMP-1水平）之间的关系。
一项前瞻性队列研究。
23例哮喘患者（62%）和2例对照者（20%）存在至少一支扩张支气管[p = 0.030]。哮喘患者中每位受试者扩张支气管与所有符合条件支气管的比例（个体BD%）高于对照者（11.4±16.1% 对1.3±3.0%，p = 0.011）[均值±标准差]。有BD（n = 23）和无BD（n = 14）的哮喘患者在年龄、哮喘病程和严重程度、特应性、肺功能、痰液嗜酸性粒细胞或中性粒细胞计数以及痰液MMP-9或TIMP-1水平及其摩尔比方面相似。哮喘患者的个体BD%也与这些临床和痰液变量无关。然而，当分析仅限于23例有BD的患者时，个体BD%与哮喘严重程度评分相关（r = 0.49，p = 0.023）。19例患者的随访HRCT结果提示BD是一种固定而非短暂的现象。
哮喘患者中BD比正常受试者更常见，且可能与哮喘严重程度相关。本研究未证实细胞炎症或MMP-9与TIMP-1之间可能的失衡与哮喘中的BD相关。
