Kogo Mariko, Matsumoto Hisako, Tanabe Naoya, Chen-Yoshikawa Toyofumi F, Nakajima Naoki, Yoshizawa Akihiko, Oguma Tsuyoshi, Sato Susumu, Nomura Natsuko, Morimoto Chie, Sunadome Hironobu, Gotoh Shimpei, Ohsumi Akihiro, Date Hiroshi, Hirai Toyohiro
Dept of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
These authors contributed equally to this work.
ERJ Open Res. 2021 Oct 25;7(4). doi: 10.1183/23120541.00123-2021. eCollection 2021 Oct.
Bronchiolitis obliterans (BO) is a clinical syndrome characterised by progressive small airway obstruction, causing significant morbidity and mortality. Central airway dilatation is one of its radiological characteristics, but little is known about the clinical and pathological associations between airway dilatation and BO.
This retrospective study consecutively included patients who underwent lung transplantation due to BO at Kyoto University Hospital from 2009 to 2019. Demographic and histopathological findings of the resected lungs were compared between patients with and without airway dilatation measured by chest computed tomography (CT) at registration for lung transplantation.
Of a total of 38 included patients (median age, 30 years), 34 (89%) had a history of hematopoietic stem-cell transplantation, and 22 (58%) had airway dilatation based on CT. Patients with airway dilatation had a higher frequency of isolation with greater residual volume than those without airway dilatation. Quantitative CT analysis revealed an increase in lung volume to predictive total lung capacity and a percentage of low attenuation volume <-950 HU at inspiration in association with the extent of airway dilatation. Airway dilatation on CT was associated with an increased number of bronchioles with concentric narrowing of the lumen and thickening of the subepithelium of the walls on histology.
In patients with BO, airway dilatation may reflect increased residual volume or air trapping and pathological extent of obstructive bronchioles, accompanied by a risk of isolation. More attention should be paid to the development of airway dilatation in the management of BO.
闭塞性细支气管炎（BO）是一种临床综合征，其特征为进行性小气道阻塞，可导致显著的发病率和死亡率。中央气道扩张是其影像学特征之一，但关于气道扩张与BO之间的临床和病理关联知之甚少。
这项回顾性研究连续纳入了2009年至2019年在京都大学医院因BO接受肺移植的患者。比较了在肺移植登记时通过胸部计算机断层扫描（CT）测量有或无气道扩张的患者切除肺的人口统计学和组织病理学结果。
在总共38例纳入患者（中位年龄30岁）中，34例（89%）有造血干细胞移植史，22例（58%）基于CT有气道扩张。有气道扩张的患者比没有气道扩张的患者隔离频率更高，残气量更大。定量CT分析显示，肺容积相对于预测的肺总量增加，吸气时低衰减容积百分比<-950 HU与气道扩张程度相关。CT上的气道扩张与组织学上管腔同心性狭窄和壁上皮下增厚的细支气管数量增加有关。
在BO患者中，气道扩张可能反映残气量增加或气体潴留以及阻塞性细支气管的病理程度，并伴有隔离风险。在BO的管理中应更加关注气道扩张的发展。
