Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine.
Veterans Affairs Medical Center.
Am J Surg Pathol. 2021 Dec 1;45(12):1587-1596. doi: 10.1097/PAS.0000000000001757.
After deployment to Southwest Asia, some soldiers develop persistent respiratory symptoms, including exercise intolerance and exertional dyspnea. We identified 50 soldiers with a history of deployment to Southwest Asia who presented with unexplained dyspnea and underwent an unrevealing clinical evaluation followed by surgical lung biopsy. Lung tissue specimens from 17 age-matched, nonsmoking subjects were used as controls. Quantitative histomorphometry was performed for evaluation of inflammation and pathologic remodeling of small airways, pulmonary vasculature, alveolar tissue and visceral pleura. Compared with control subjects, lung biopsies from affected soldiers revealed a variety of pathologic changes involving their distal lungs, particularly related to bronchovascular bundles. Bronchioles from soldiers had increased thickness of the lamina propria, smooth muscle hypertrophy, and increased collagen content. In adjacent arteries, smooth muscle hypertrophy and adventitial thickening resulted in increased wall-to-lumen ratio in affected soldiers. Infiltration of CD4 and CD8 T lymphocytes was noted within airway walls, along with increased formation of lymphoid follicles. In alveolar parenchyma, collagen and elastin content were increased and capillary density was reduced in interalveolar septa from soldiers compared to control subjects. In addition, pleural involvement with inflammation and/or fibrosis was present in the majority (92%) of soldiers. Clinical follow-up of 29 soldiers (ranging from 1 to 15 y) showed persistence of exertional dyspnea in all individuals and a decline in total lung capacity. Susceptible soldiers develop a postdeployment respiratory syndrome that includes exertional dyspnea and complex pathologic changes affecting small airways, pulmonary vasculature, alveolar tissue, and visceral pleura.
部署到西南亚后，一些士兵出现持续性呼吸系统症状，包括运动不耐受和运动性呼吸困难。我们确定了 50 名有部署到西南亚经历并出现不明原因呼吸困难的士兵，他们接受了无明显异常的临床评估和随后的手术肺活检。17 名年龄匹配、不吸烟的对照者的肺组织标本用于对照。进行定量组织形态计量学评估以评估小气道、肺血管、肺泡组织和内脏胸膜的炎症和病理性重塑。与对照者相比，受影响士兵的肺活检显示出各种涉及其远端肺部的病理变化，特别是与支气管血管束有关的变化。士兵的细支气管固有层增厚、平滑肌肥大和胶原含量增加。相邻动脉的平滑肌肥大和外膜增厚导致受影响士兵的壁腔比增加。在气道壁内以及淋巴滤泡形成增加的情况下，观察到 CD4 和 CD8 T 淋巴细胞浸润。与对照者相比，肺泡实质中的胶原和弹性蛋白含量增加，肺泡间隔中的毛细血管密度降低。此外，大多数（92%）士兵的胸膜存在炎症和/或纤维化。对 29 名士兵（随访时间 1 至 15 年）的临床随访显示，所有患者均持续存在运动性呼吸困难，且肺活量下降。易感士兵会出现一种部署后呼吸系统综合征，包括运动性呼吸困难和影响小气道、肺血管、肺泡组织和内脏胸膜的复杂病理变化。
