晚期肺气肿的小气道病变和支气管逆转性。

Small airway pathology and bronchoreversibility in advanced emphysema.

机构信息

Division of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, United States.

出版信息

COPD. 2010 Apr;7(2):93-101. doi: 10.3109/15412551003631691.

DOI:10.3109/15412551003631691

PMID:20397809

Abstract

BACKGROUND

Poorly reversible airflow obstruction is a hallmark feature of chronic obstructive pulmonary disease (COPD). However, some COPD patients demonstrate significant bronchodilator reversibility (BDR). The pathologic features associated with the presence or absence of this phenomenon are not known.

METHODS

We analyzed 67 patients with advanced upper lobe predominant emphysema who underwent lung volume reduction surgery and divided them into 2 groups: the reversible group [BD(+)] had a >12% and >200 mL increase in FEV(1) or FVC with bronchodilator; the irreversible group [BD(-)] had a <or=12% and <or=20 mL increase in FEV(1) and FVC. We measured the epithelial height (EH) and areas of epithelium (EA), subepithelium (SEA), smooth muscle (SMWA), and total wall (TWA) of the small airways (<2 mm in internal diameter) in the resected specimens, and adjusted these measurements for basement membrane area (BMA) or perimeter (BMP).

RESULTS

Despite similar baseline characteristics, the BD(+) group had a smaller EH (0.036 mm vs. 0.042 mm, p = 0.005) and EH/BMP (0.012 vs. 0.014, p = 0.007), and a greater SMWA/BMA (0.491 vs. 0.430, p = 0.034) compared to the BD(-) group. In addition, EA trended to be smaller in the BD(+) group when compared to the BD(-) group (0.160 mm(2) vs. 0.184 mm(2), p = 0.06). In a subset of patients with consistent patterns of BDR on serial testing, the BD(+) group had greater SMWA/BMA (0.518 vs. 0.433, p = 0.049) and TWA/BMA (1.405 vs. 1.266, p = 0.036) compared to the BD(-) group.

CONCLUSIONS

Small airway smooth muscle mass may play a role in determining BDR in severe emphysema.

摘要

背景

气流受限不可完全逆转是慢性阻塞性肺疾病（COPD）的主要特征之一。然而，一些 COPD 患者表现出显著的支气管扩张剂可逆性（BDR）。与这种现象存在或不存在相关的病理特征尚不清楚。

方法

我们分析了 67 例接受肺减容手术的晚期上叶为主型肺气肿患者，将其分为 2 组：支气管扩张剂后 FEV1 或 FVC 增加>12%且>200 mL 的可逆组[BD(+)]；支气管扩张剂后 FEV1 和 FVC 增加<or=12%且<or=20 mL 的不可逆转组[BD(-)]。我们测量了切除标本中小气道（内径<2 毫米）的上皮高度（EH）和上皮面积（EA）、黏膜下区（SEA）、平滑肌面积（SMWA）和总壁面积（TWA），并根据基底膜面积（BMA）或周长（BMP）对这些测量值进行了调整。

结果

尽管存在相似的基线特征，但 BD(+)组的 EH 较小（0.036 毫米对 0.042 毫米，p=0.005），EH/BMP 也较小（0.012 对 0.014，p=0.007），SMWA/BMA 较大（0.491 对 0.430，p=0.034）。此外，与 BD(-)组相比，BD(+)组的 EA 也较小（0.160 毫米对 0.184 毫米，p=0.06）。在一组连续测试中具有一致 BDR 模式的患者亚组中，BD(+)组的 SMWA/BMA 较大（0.518 对 0.433，p=0.049），TWA/BMA 也较大（1.405 对 1.266，p=0.036）。