Nagai A, Yamawaki I, Takizawa T, Thurlbeck W M
First Department of Medicine, Tokyo Women's Medical College, Japan.
Am Rev Respir Dis. 1991 Oct;144(4):888-91. doi: 10.1164/ajrccm/144.4.888.
We have studied alveolar attachments to membranous bronchioles in 41 patients enrolled in the National Institutes of Health Intermittent Positive Pressure Breathing Trial who died, came to autopsy, and provided adequate tissue for examination. The patients had moderate to severe chronic airflow obstruction and, on the average, severe emphysema. We measured the number of normal attachments per membranous bronchiole per case (N), the number of normal attachments per mm of circumference per bronchiole per case (Nunit), and the ratio of abnormal to all attachments (R). All measurements correlated closely to all measurements of emphysema and to irregular shape of bronchioles (deformity index). Measurement of abnormal attachments correlated with abnormal tests of pulmonary function, including evidence of airflow obstruction and diffusing capacity for carbon monoxide (DLCO). Nunit showed the most frequent correlations, but both N and Nunit were only related independently of emphysema for Phase III of the single-breath nitrogen test. R was related to loss of DLCO. We conclude that loss of attachments is not itself a cause of airflow obstruction but rather a correlate of emphysema, which is the proximate cause of the obstruction. Loss of alveolar attachments has an effect only on the single-breath nitrogen tests independent of emphysema.
我们研究了美国国立卫生研究院间歇性正压呼吸试验中41例死亡并接受尸检且提供了足够组织用于检查的患者的肺泡与膜性细支气管的附着情况。这些患者患有中度至重度慢性气流阻塞，平均有严重的肺气肿。我们测量了每例患者每个膜性细支气管的正常附着数（N）、每例患者每个细支气管每毫米周长的正常附着数（Nunit）以及异常附着与所有附着的比例（R）。所有测量结果都与肺气肿的所有测量结果以及细支气管的不规则形状（畸形指数）密切相关。异常附着的测量与肺功能异常测试相关，包括气流阻塞和一氧化碳弥散量（DLCO）的证据。Nunit显示出最频繁的相关性，但仅在单次呼吸氮试验的第三阶段，N和Nunit才独立于肺气肿相关。R与DLCO的降低有关。我们得出结论，附着丧失本身不是气流阻塞的原因，而是肺气肿的一个相关因素，肺气肿是阻塞的直接原因。肺泡附着丧失仅对独立于肺气肿的单次呼吸氮试验有影响。
