Souquet P J, Tebib J, Massonnet B, Azzar D, Letanche G, Bernard J P, Bouvier M, Touraine R
Service de Pneumologie, Centre Hospitalier Lyon Sud, Pierre-Bénite.
Rev Mal Respir. 1988;5(6):615-7.
Bi-apical pulmonary fibrosis particular to ankylosing spondylitis is found in 1 to 10% of cases. The non-specific fibrosis or fibrosis of a more specific character such as iritis or the aortic disease are discussed. The fibrosis may be provoked by repeated infections which would favour an eventual hypoventilation at the apices secondary to the rigidity of the thoracic cage. To test this hypothesis we have studied muco-ciliary clearance in 10 subjects presenting with ankylosing spondylitis without any pulmonary radiological lesion and have compared these to 7 control subjects. No statistical difference was found in the clearance rate between the control subjects and the patients on the one hand (whether or not they had extra articular manifestations) and between the different areas of the lung (notably superior and inferior) in patients on the other hand. Thus this bi-apical fibrosis does not seem to explain the phenomena repeated infections at the apices which might have been favoured by any secondary deficiency in muco-ciliary clearance and hypoventilation of the apices. It seems most likely that the fibrosis has a specific origin related to the nature of the disease.
强直性脊柱炎特有的双肺尖部肺纤维化见于1%至10%的病例。文中讨论了非特异性纤维化或具有更特异性特征的纤维化,如虹膜炎或主动脉疾病。纤维化可能由反复感染引发,这会促使胸廓僵硬继发肺尖部最终出现通气不足。为验证这一假设,我们研究了10名无任何肺部放射学病变的强直性脊柱炎患者的黏液纤毛清除功能,并将其与7名对照受试者进行比较。一方面,对照受试者与患者之间(无论是否有关节外表现)以及另一方面患者肺部不同区域(尤其是上叶和下叶)之间的清除率均未发现统计学差异。因此,这种双肺尖部纤维化似乎无法解释肺尖部反复感染的现象,而黏液纤毛清除功能的任何继发性缺陷和肺尖部通气不足可能会助长这种感染。纤维化似乎极有可能有与疾病性质相关的特定起源。