Al-Kassimi Feisal A, Alhamad Esam H, Al-Hajjaj Mohammed S, Raddaoui Emad, Alzeer Abdulaziz H, Alboukai Ahmad A, Somily Ali M, Cal Joseph G, Ibrahim Abdalla F, Shaik Shaffi A
Department of Medicine, King Saud University, Riyadh, Saudi Arabia.
Department of Pathology, Alfaisal University, Riyadh, Saudi Arabia.
Respirology. 2017 Feb;22(2):322-328. doi: 10.1111/resp.12902. Epub 2016 Sep 13.
Post-mortem and computed tomography (CT) studies indicated that emphysema is a feature of COPD even in the 'blue bloater/chronic bronchitis' type. We aim to test the hypothesis that the non-emphysematous patients are distinct from the main body of COPD and are more akin to asthmatic patients.
We studied 54 patients with COPD. Emphysema was measured by Goddard's visual scoring of CT scan and the carbon monoxide transfer coefficient (KCO). Bronchial biopsy was offered for thickness of basement membrane (BM) (≥7 µm) as a marker of remodelling in irreversible asthma. Spirometry was repeated after therapy with Budesonide/Formoterol for 1 year.
The non-emphysematous phenotype were 24 of 54 patients (44%) by CT scan and 23 of 54 patients (43%) by KCO, showing agreement in 53 out of 54 patients. The non-emphysematous patients were younger, had higher forced expiratory volume in 1 s (FEV ) (median 61% vs 49.7%), greater prevalence of hypertrophy of nasal turbinates and higher serum IgE. The emphysematous phenotype had lower BMI and greater dyspnoea score. The BM was thickened in 11 of 14 and 0 of 10 patients in the non-emphysematous and emphysematous groups, respectively. Three patients without emphysema and a normal BM normalized their FEV upon receiving inhaled corticosteroid (ICS)/long-acting β2 agonist (LABA). All the non-emphysematous improved their FEV after ICS/LABA (median = 215 mL). The median decline in the emphysematous was -65 mL.
The non-emphysematous phenotype of COPD displays important features of asthma: clinical picture, histology and response to ICS. CT and KCO can predict spirometric response to ICS/LABA.
尸检和计算机断层扫描（CT）研究表明，即使在“蓝肿型/慢性支气管炎”类型的慢性阻塞性肺疾病（COPD）中，肺气肿也是其特征之一。我们旨在验证以下假设：非肺气肿型患者与COPD主体不同，更类似于哮喘患者。
我们研究了54例COPD患者。通过戈达德对CT扫描的视觉评分和一氧化碳转运系数（KCO）来测量肺气肿。对支气管活检组织进行基底膜（BM）厚度（≥7μm）检测，作为不可逆性哮喘重塑的标志物。使用布地奈德/福莫特罗治疗1年后重复进行肺功能测定。
通过CT扫描，54例患者中有24例（44%）为非肺气肿型表型；通过KCO检测，54例患者中有23例（43%）为非肺气肿型表型，54例患者中有53例结果一致。非肺气肿型患者更年轻，第1秒用力呼气容积（FEV₁）更高（中位数分别为61%和49.7%），鼻甲肥大的患病率更高，血清IgE也更高。肺气肿型表型的体重指数（BMI）更低，呼吸困难评分更高。非肺气肿组14例患者中有11例BM增厚，肺气肿组10例患者中无一例BM增厚。3例无肺气肿且BM正常的患者在接受吸入性糖皮质激素（ICS）/长效β₂受体激动剂（LABA）治疗后FEV₁恢复正常。所有非肺气肿型患者在接受ICS/LABA治疗后FEV₁均有所改善（中位数 = 215 mL）。肺气肿型患者FEV₁的中位数下降为 -65 mL。
COPD的非肺气肿型表型表现出哮喘的重要特征：临床表现、组织学及对ICS的反应。CT和KCO可预测对ICS/LABA的肺功能反应。
