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健康与阻塞性肺疾病状态下气道的系统生理学

Systems physiology of the airways in health and obstructive pulmonary disease.

作者信息

Bates Jason H T

机构信息

Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA.

出版信息

Wiley Interdiscip Rev Syst Biol Med. 2016 Sep;8(5):423-37. doi: 10.1002/wsbm.1347. Epub 2016 Jun 24.

Abstract

Fresh air entering the mouth and nose is brought to the blood-gas barrier in the lungs by a repetitively branching network of airways. Provided the individual airway branches remain patent, this airway tree achieves an enormous amplification in cross-sectional area from the trachea to the terminal bronchioles. Obstructive lung diseases such as asthma occur when airway patency becomes compromised. Understanding the pathophysiology of these obstructive diseases thus begins with a consideration of the factors that determine the caliber of an individual airway, which include the force balance between the inward elastic recoil of the airway wall, the outward tethering forces of its parenchymal attachments, and any additional forces due to contraction of airway smooth muscle. Other factors may also contribute significantly to airway narrowing, such as thickening of the airway wall and accumulation of secretions in the lumen. Airway obstruction becomes particularly severe when these various factors occur in concert. However, the effect of airway abnormalities on lung function cannot be fully understood only in terms of what happens to a single airway because narrowing throughout the airway tree is invariably heterogeneous and interdependent. Obstructive lung pathologies thus manifest as emergent phenomena arising from the way in which the airway tree behaves a system. These emergent phenomena are studied with clinical measurements of lung function made by spirometry and by mechanical impedance measured with the forced oscillation technique. Anatomically based computational models are linking these measurements to underlying anatomic structure in systems physiology terms. WIREs Syst Biol Med 2016, 8:423-437. doi: 10.1002/wsbm.1347 For further resources related to this article, please visit the WIREs website.

摘要

经口鼻进入的新鲜空气通过反复分支的气道网络被带到肺部的气血屏障处。只要各个气道分支保持通畅,从气管到终末细支气管,这个气道树的横截面积会极大地增大。当气道通畅性受损时,就会发生诸如哮喘之类的阻塞性肺病。因此,要理解这些阻塞性疾病的病理生理学,首先要考虑决定单个气道管径的因素,这些因素包括气道壁向内的弹性回缩力、实质组织附着的向外牵拉力量以及气道平滑肌收缩产生的任何额外力量。其他因素也可能对气道狭窄有显著影响,比如气道壁增厚和管腔内分泌物积聚。当这些各种因素共同作用时,气道阻塞会变得尤为严重。然而,仅从单个气道的情况来理解气道异常对肺功能的影响是不够的,因为整个气道树的狭窄总是不均匀且相互依存的。因此,阻塞性肺部病变表现为由气道树作为一个系统的行为方式所产生的涌现现象。这些涌现现象通过肺功能的临床测量(肺活量测定)以及用强迫振荡技术测量的机械阻抗来研究。基于解剖学的计算模型正在将这些测量结果与系统生理学层面的基础解剖结构联系起来。《WIREs系统生物学与医学》2016年,8卷:423 - 437页。doi: 10.1002/wsbm.1347 有关本文的更多资源,请访问WIREs网站。

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