Respiratory and Sleep Medicine, Monash University and Medical Centre, 246 Clayton Road, Clayton 3168, Melbourne, Australia.
Am J Respir Crit Care Med. 2011 Jul 1;184(1):50-6. doi: 10.1164/rccm.201010-1604OC. Epub 2011 Mar 31.
Upper airway dysfunction may complicate asthma but has been largely ignored as an etiological factor. Diagnosis using endoscopic evaluation of vocal cord function is difficult to quantify, with limited clinical application.
A novel imaging technique, dynamic 320-slice computerized tomography (CT), was used to examine laryngeal behavior in healthy individuals and individuals with asthma.
Vocal cord movement was imaged using 320-slice CT larynx. Healthy volunteers were studied to develop and validate an analysis algorithm for quantification of normal vocal cord function. Further studies were then conducted in 46 patients with difficult-to-treat asthma.
Vocal cord movement was quantified over the breathing cycle by CT using the ratio of vocal cord diameter to tracheal diameter. Normal limits were calculated, validated, and applied to evaluate difficult-to-treat asthma. Vocal cord movement was abnormal with excessive narrowing in 23 of 46 (50%) patients with asthma and severe in 9 (19%) patients (abnormal > 50% of inspiration or expiration time). Imaging also revealed that laryngeal dysfunction characterized the movement abnormality rather than isolated vocal cord dysfunction.
Noninvasive quantification of laryngeal movement was achieved using CT larynx. Significant numbers of patients with difficult-to-treat asthma had excessive narrowing of the vocal cords. This new approach has identified frequent upper airway dysfunction in asthma with potential implications for disease control and treatment.
上呼吸道功能障碍可能使哮喘复杂化，但作为一个病因因素，它在很大程度上被忽视了。使用声带功能的内镜评估进行诊断难以量化，临床应用有限。
一种新的成像技术，即动态 320 层计算机断层扫描（CT），被用于检查健康个体和哮喘患者的喉部行为。
使用 320 层 CT 喉部对声带运动进行成像。对健康志愿者进行了研究，以开发和验证一种用于量化正常声带功能的分析算法。然后在 46 例治疗困难的哮喘患者中进行了进一步的研究。
通过 CT 使用声带直径与气管直径的比值来量化呼吸周期中的声带运动。计算、验证并应用正常范围来评估治疗困难的哮喘。在 46 例哮喘患者中，有 23 例（50%）患者的声带运动异常，存在过度狭窄，9 例（19%）患者严重（异常>呼吸或呼气时间的 50%）。影像学还显示，喉功能障碍是运动异常的特征，而不是孤立的声带功能障碍。
使用 CT 喉部实现了对喉部运动的非侵入性定量。相当数量的治疗困难的哮喘患者存在声带过度狭窄。这种新方法在哮喘中发现了频繁的上呼吸道功能障碍，这可能对疾病控制和治疗有影响。
