哮喘气道高反应性的结构基础。
The structural basis of airways hyperresponsiveness in asthma.
作者信息
Brown Robert H, Pearse David B, Pyrgos George, Liu Mark C, Togias Alkis, Permutt Solbert
机构信息
Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
出版信息
J Appl Physiol (1985). 2006 Jul;101(1):30-9. doi: 10.1152/japplphysiol.01190.2005. Epub 2006 Feb 9.
We hypothesized that structural airway remodeling contributes to airways hyperresponsiveness (AHR) in asthma. Small, medium, and large airways were analyzed by computed tomography in 21 asthmatic volunteers under baseline conditions (FEV1 = 64% predicted) and after maximum response to albuterol (FEV1 = 76% predicted). The difference in pulmonary function between baseline and albuterol was an estimate of AHR to the baseline smooth muscle tone (BSMT). BSMT caused an increase in residual volume (RV) that was threefold greater than the decrease in forced vital capacity (FVC) because of a simultaneous increase in total lung capacity (TLC). The decrease in FVC with BSMT was the major determinant of the baseline FEV1 (P < 0.0001). The increase in RV correlated inversely with the relaxed luminal diameter of the medium airways (P = 0.009) and directly with the wall thickness of the large airways (P = 0.001). The effect of BSMT on functional residual capacity (FRC) controlled the change in TLC relative to the change in RV. When the FRC increased with RV, TLC increased and FVC was preserved. When the relaxed large airways were critically narrowed, FRC and TLC did not increase and FVC fell. With critical large airways narrowing, the FRC was already elevated from dynamic hyperinflation before BSMT and did not increase further with BSMT. FEV1/FVC in the absence of BSMT correlated directly with large airway luminal diameter and inversely with the fall in FVC with BSMT. These findings suggest that dynamic hyperinflation caused by narrowing of large airways is a major determinant of AHR in asthma.
我们假设气道结构重塑会导致哮喘患者的气道高反应性(AHR)。对21名哮喘志愿者在基线条件下(FEV1为预测值的64%)以及对沙丁胺醇最大反应后(FEV1为预测值的76%)进行计算机断层扫描,分析小气道、中气道和大气道情况。基线与沙丁胺醇之间肺功能的差异是对基线平滑肌张力(BSMT)的AHR的一个估计值。BSMT导致残气量(RV)增加,由于肺总量(TLC)同时增加,其增加幅度比用力肺活量(FVC)的降低幅度大三倍。BSMT导致的FVC降低是基线FEV1的主要决定因素(P < 0.0001)。RV的增加与中气道舒张时的管腔直径呈负相关(P = 0.009),与大气道的壁厚呈正相关(P = 0.001)。BSMT对功能残气量(FRC)的影响控制了TLC相对于RV变化的改变。当FRC随RV增加时,TLC增加且FVC得以保留。当舒张的大气道严重狭窄时,FRC和TLC不增加且FVC下降。在大气道严重狭窄时,FRC在BSMT之前就已因动态肺过度充气而升高,并且不会因BSMT进一步增加。在没有BSMT的情况下,FEV1/FVC与大气道管腔直径直接相关,与BSMT导致的FVC下降呈负相关。这些发现表明,大气道狭窄导致的动态肺过度充气是哮喘患者AHR的主要决定因素。