Paredi P, Barnes P J
National Heart and Lung Institute, London, UK.
Thorax. 2009 May;64(5):444-50. doi: 10.1136/thx.2008.100032.
It is increasingly recognised that the airway circulation plays an important role in airway diseases, either through a change in blood flow or through microvascular leakage. Most of the information available regarding the anatomy and physiology of bronchial blood flow and its regulation has necessarily derived from animal studies. However, there have recently been important advances in understanding airway blood flow in airway disease in humans through the development of non-invasive methods and in the quantification of microvascular leakage using plasma markers. These studies have shown that bronchial blood flow is increased in patients with asthma but not in those with chronic obstructive pulmonary disease, confirming previous pathology investigations. Changes in bronchial blood flow may in part reflect the generation of new vascular vessels, a process known as "angiogenesis" which is caused by airway inflammation. Angiogenesis and the resulting plasma leak affect airway physiology, drug clearance and its bioavailability. This review discusses the anatomy, physiology and regulation of bronchial blood flow in the normal and diseased lung, In addition, it analyses the effect of current medical treatment and discusses the potential use of new anti-angiogenesis medications. The development of non-invasive assessment of bronchial blood flow and the study of angiogenesis have provided a tool to investigate airway physiology in vivo; these advances will contribute to a better understanding of inflammatory airway diseases as well as the implication of these findings to management.
人们越来越认识到，气道循环在气道疾病中起着重要作用，无论是通过血流变化还是微血管渗漏。目前关于支气管血流的解剖学、生理学及其调节的大多数信息必然来自动物研究。然而，最近通过无创方法的发展以及使用血浆标志物对微血管渗漏进行量化，在了解人类气道疾病中的气道血流方面取得了重要进展。这些研究表明，哮喘患者的支气管血流增加，而慢性阻塞性肺疾病患者则不然，这证实了先前的病理学研究。支气管血流的变化可能部分反映了新血管的生成，这一过程称为“血管生成”，是由气道炎症引起的。血管生成和由此导致的血浆渗漏会影响气道生理、药物清除及其生物利用度。本综述讨论了正常和患病肺中支气管血流的解剖学、生理学和调节。此外，它分析了当前药物治疗的效果，并讨论了新型抗血管生成药物的潜在用途。支气管血流无创评估的发展和血管生成的研究为体内研究气道生理提供了一种工具；这些进展将有助于更好地理解炎症性气道疾病以及这些发现对治疗的意义。
