Pavia D, Agnew J E, Sutton P P, Lopez-Vidriero M T, Currie D C, Cole P J, Clarke S W
Department of Thoracic Medicine, Royal Free Hospital, London, UK.
Respiration. 1988;53(3):187-96. doi: 10.1159/000195412.
Published reports have indicated that patients with Kartagener's syndrome (dextrocardia, sinusitis and bronchiectasis) have no significant lung mucociliary clearance. With a radioaerosol technique we measured over a 6-hour observation period the tracheobronchial clearance of 8 patients with dextrocardia, chronic bronchial sepsis and chronic sinusitis (DC). The tracheobronchial clearance of these patients was significantly reduced (p less than 0.02) compared with that of 29 healthy subjects of similar age. However, even when allowance was made for productive coughing during the observation period, the reduced clearance was much better than anticipated from published reports in patients with Kartagener's syndrome, which confined their observations to a 2-hour period. The tracheobronchial clearance of the DC patients, adjusted for productive coughing, was as bad as that found in an older group of patients with chronic obstructive airways disease who refrained from expectorating during the equivalent test period. Our study implies one or more of the following possibilities: (a) a spectrum of mucociliary impairment in patients with DC; (b) an effective cough clearance deeper in the lung than hitherto believed, and (c) two-phase flow of mucus cephalad as an effective clearance mechanism in patients with DC.
已发表的报告表明，患有卡塔格内综合征（右位心、鼻窦炎和支气管扩张）的患者没有明显的肺黏液纤毛清除功能。我们采用放射性气溶胶技术，在6小时的观察期内测量了8例右位心、慢性支气管感染和慢性鼻窦炎（DC）患者的气管支气管清除功能。与29名年龄相仿的健康受试者相比，这些患者的气管支气管清除功能显著降低（p<0.02）。然而，即使考虑到观察期内的咳痰情况，这些患者降低的清除功能仍比已发表报告中卡塔格内综合征患者的预期要好得多，那些报告的观察期仅为2小时。经咳痰调整后，DC患者的气管支气管清除功能与一组年龄较大的慢性阻塞性气道疾病患者在相同测试期内不咳痰时的情况一样差。我们的研究提示以下一种或多种可能性：（a）DC患者存在一系列黏液纤毛功能障碍；（b）肺部深处存在比迄今认为更有效的咳嗽清除功能；（c）黏液向头侧的两相流动是DC患者有效的清除机制。
