Lu Dongzhu, Yu Qing, Chen Lichang, Liao Qiannuan, Lan Junkang, Chen Shu-Bing, Wang Cuilan, Zeng Wenyi, Wu Lingling, Fan Chaofan, Lu Peifeng, Yu Huapeng
Department of Pulmonary and Critical Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
J Asthma. 2023 Jan;60(1):32-42. doi: 10.1080/02770903.2021.2023821. Epub 2022 Jan 13.
We aimed to explore whether large airway remodeling and small airway structural changes exist in subjects with small airway asthma phenotype and to evaluate the relationships between quantitative high-resolution computed tomography (qHRCT) parameters and lung function.
We enrolled 15 subjects with small airway asthma phenotype and 18 healthy controls. The two groups were matched by age, sex and body square area (BSA) with propensity score matching (PSM). Pulmonary function and qHRCT parameters [wall thickness (WT), wall area (WA), lumen area (LA), wall area percentage (WA%) of the 4th-6th generations in the right upper lobe apical segmental bronchus (RB1), adjusted by BSA, WT/BSA, WA/BSA, and LA/BSA, relative volume change -860 HU to -950 HU (RVC) and the expiration to inspiration ratio of mean lung density (MLD)) were compared between the groups. Correlation analysis was employed to assess the relationship between qHRCT parameters and pulmonary function.
The small airway asthma phenotype had significantly higher WA%, RVC and MLD and lower LA/BSA than the healthy control. Additionally, we found moderate to strong correlations between impulse oscillation (IOS) indices and WA6% and WT6/BSA. No significant correlation was found between bronchial parameters and air trapping parameters ( > 0.05).
Combining physiological tests with imaging approaches can lead to better evaluation of small airway disfunction (SAD) in asthmatic patients. Additionally, despite nonexistent airflow obstruction in patients with small airway asthma phenotype, large airway remodeling and small airway structural changes may appear simultaneously in the early stage of disease.
我们旨在探讨小气道哮喘表型患者是否存在大气道重塑和小气道结构改变，并评估定量高分辨率计算机断层扫描（qHRCT）参数与肺功能之间的关系。
我们纳入了15例小气道哮喘表型患者和18名健康对照者。通过倾向得分匹配（PSM）使两组在年龄、性别和体表面积（BSA）方面相匹配。比较两组的肺功能和qHRCT参数[壁厚（WT）、壁面积（WA）、管腔面积（LA）、右上叶尖段支气管（RB1）第4 - 6代的壁面积百分比（WA%），经BSA校正后的WT/BSA、WA/BSA和LA/BSA、相对体积变化-860 HU至-950 HU（RVC）以及平均肺密度（MLD）的呼气与吸气比值]。采用相关性分析评估qHRCT参数与肺功能之间的关系。
小气道哮喘表型患者的WA%、RVC和MLD显著高于健康对照者，而LA/BSA则较低。此外，我们发现脉冲振荡（IOS）指标与WA6%和WT6/BSA之间存在中度至强相关性。支气管参数与气体潴留参数之间未发现显著相关性（>0.05）。
将生理测试与影像学方法相结合可以更好地评估哮喘患者的小气道功能障碍（SAD）。此外，尽管小气道哮喘表型患者不存在气流阻塞，但在疾病早期可能同时出现大气道重塑和小气道结构改变。
