慢性阻塞性肺疾病肺减容术后的生存情况：来自小气道病理学的见解
Survival after lung volume reduction in chronic obstructive pulmonary disease: insights from small airway pathology.
作者信息
Hogg James C, Chu Fanny S F, Tan Wan C, Sin Don D, Patel Sanjay A, Pare Peter D, Martinez Fernando J, Rogers Robert M, Make Barry J, Criner Gerard J, Cherniack Reuben M, Sharafkhaneh Amir, Luketich James D, Coxson Harvey O, Elliott W Mark, Sciurba Frank C
机构信息
University of British Columbia iCAPTURE Centre for Cardiovascular and Pulmonary Research, St. Paul's Hospital, Vancouver, BC, Canada.
出版信息
Am J Respir Crit Care Med. 2007 Sep 1;176(5):454-9. doi: 10.1164/rccm.200612-1772OC. Epub 2007 Jun 7.
RATIONALE
COPD is associated with reduced life expectancy.
OBJECTIVES
To determine the association between small airway pathology and long-term survival after lung volume reduction in chronic obstructive pulmonary disease (COPD) and the effect of corticosteroids on this pathology.
METHODS
Patients with severe (GOLD-3) and very severe (GOLD-4) COPD (n = 101) were studied after lung volume reduction surgery. Respiratory symptoms, quality of life, pulmonary function, exercise tolerance, chest radiology, and corticosteroid treatment status were assessed preoperatively. The severity of luminal occlusion, wall thickening, and the presence of small airways containing lymphoid follicles were determined in resected lung tissue. Kaplan-Meier survival analysis and Cox proportional hazards models were used to determine the relationship between survival and small airway pathology. The effect of corticosteroids on this pathology was assessed by comparing treated and untreated groups.
MEASUREMENTS AND MAIN RESULTS
The quartile of subjects with the greatest luminal occlusion, adjusted for covariates, died earlier than subjects who had the least occlusion (hazard ratio, 3.28; 95% confidence interval, 1.55-6.92; P = 0.002). There was a trend toward a reduction in the number of airways containing lymphoid follicles (P = 0.051) in those receiving corticosteroids, with a statistically significant difference between the control and oral +/- inhaled corticosteroid-treated groups (P = 0.019). However, corticosteroid treatment had no effect on airway wall thickening or luminal occlusion.
CONCLUSIONS
Occlusion of the small airways by inflammatory exudates containing mucus is associated with early death in patients with severe emphysema treated by lung volume reduction surgery. Corticosteroid treatment dampens the host immune response in these airways by reducing lymphoid follicles without changing wall thickening and luminal occlusion.
原理
慢性阻塞性肺疾病（COPD）与预期寿命缩短有关。
目的
确定慢性阻塞性肺疾病（COPD）患者肺减容术后小气道病理与长期生存之间的关联，以及皮质类固醇对这种病理的影响。
方法
对101例重度（GOLD-3）和极重度（GOLD-4）COPD患者进行肺减容手术后进行研究。术前评估呼吸症状、生活质量、肺功能、运动耐量、胸部放射学和皮质类固醇治疗状态。在切除的肺组织中确定管腔阻塞的严重程度、壁增厚情况以及含有淋巴滤泡的小气道的存在情况。采用Kaplan-Meier生存分析和Cox比例风险模型来确定生存与小气道病理之间的关系。通过比较治疗组和未治疗组来评估皮质类固醇对这种病理的影响。
测量指标和主要结果
在调整协变量后，管腔阻塞最严重的四分位数受试者比阻塞最少的受试者死亡更早（风险比，3.28；95%置信区间，1.55-6.92；P = 0.002）。接受皮质类固醇治疗的患者中，含有淋巴滤泡的气道数量有减少的趋势（P = 0.051），对照组与口服 +/- 吸入皮质类固醇治疗组之间存在统计学显著差异（P = 0.019）。然而，皮质类固醇治疗对气道壁增厚或管腔阻塞没有影响。
结论
含有黏液的炎性渗出物导致的小气道阻塞与接受肺减容手术治疗的重度肺气肿患者的早期死亡有关。皮质类固醇治疗通过减少淋巴滤泡来抑制这些气道中的宿主免疫反应，而不改变壁增厚和管腔阻塞情况。
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