Wei Jinmei, Qin Shujuan, Li Wentao, Chen Yan, Feng Tingmei, Wei Yuhui, Tan Sen, Liu Guangnan
Department of Respiratory and Critical Medicine, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China.
Guangxi Medical University, Nanning, China.
Front Med (Lausanne). 2023 Jul 20;10:1202309. doi: 10.3389/fmed.2023.1202309. eCollection 2023.
Benign airway stenosis (BAS), namely airway narrowing caused by a variety of benign lesions, can lead to varying degrees of breathing difficulties and even death due to asphyxia. This study aimed to elucidate the clinical characteristics of BAS, including etiology, treatment and pathology, by analyzing the clinical data of BAS patients.
A retrospective analysis was conducted using the clinical data of 617 BAS cases from January 2017 to December 2022. The pathological characteristics of the tissues were assessed by hematoxylin-eosin (H&E) and Masson's staining. Besides, protein expression levels were determined by immunohistochemistry (IHC).
A total of 617 patients were included (333 females [53.97%] and 284 males [46.03%]), with an average age of 48.93 ± 18.30 (range 14-87). Tuberculosis ( = 306, 49.59%) and trauma ( = 179, 29.02%) were the two leading etiologies of BAS, followed by airway foreign bodies (FB, = 74, 11.99%), external compression ( = 25, 4.05%) and other etiologies ( = 33, 5.35%). Among 306 tuberculous tracheobronchial stenosis (TBTS) cases, most were females ( = 215, 70.26%), and TBTS mainly occurred in the left main bronchus ( = 97, 31.70%), followed by the right middle bronchus ( = 70 cases, 22.88%). The majority of TBTS patients ( = 259, 84.64%) were treated by interventional therapy. The condition of 179 BAS patients was ascribed to trauma, such as tracheal intubation ( = 92, 51.40%), tracheotomy ( = 69, 38.56%), injury ( = 15, 8.38%) and surgery ( = 3, 1.68%), which mostly took place in the trachea ( = 173, 96.65%). TAS patients mainly received interventional therapy ( = 168, 93.85%) and stent implantation ( = 47, 26.26%). The granulation tissues of BAS primarily featured inflammation, proliferation and fibrosis. IHC indicated the up-regulated expressions of transforming growth factor-β1 (TGF-β1), α-smooth muscle actin (α-SMA), collagen type I protein (COL-I) and vimentin, and the down-regulated expression of E-cadherin, which indicated fibrosis and epithelial-mesenchymal transition (EMT).
Tuberculosis was the main etiology, and trauma was the secondary etiology. The granulation tissues of BAS were characterized by inflammation, fibrosis and probably EMT. Comprehensive interventional therapy is an effective method of treating BAS.
良性气道狭窄（BAS），即由多种良性病变引起的气道狭窄，可导致不同程度的呼吸困难，甚至因窒息而死亡。本研究旨在通过分析BAS患者的临床资料，阐明BAS的临床特征，包括病因、治疗和病理。
对2017年1月至2022年12月期间617例BAS病例的临床资料进行回顾性分析。通过苏木精-伊红（H&E）染色和Masson染色评估组织的病理特征。此外，采用免疫组织化学（IHC）测定蛋白表达水平。
共纳入617例患者（女性333例[53.97%]，男性284例[46.03%]），平均年龄48.93±18.30岁（范围14 - 87岁）。结核病（n = 306，49.59%）和创伤（n = 179，29.02%）是BAS的两大主要病因，其次是气道异物（FB，n = 74，11.99%）、外部压迫（n = 25，4.05%）和其他病因（n = 33，5.35%）。在306例结核性气管支气管狭窄（TBTS）病例中，大多数为女性（n = 215，70.26%），TBTS主要发生在左主支气管（n = 97，31.70%），其次是右中间支气管（n = 70例，22.88%）。大多数TBTS患者（n = 259，84.64%）接受了介入治疗。179例BAS患者的病情归因于创伤，如气管插管（n = 92，51.40%）、气管切开术（n = 69，38.56%）、损伤（n = 15，8.38%）和手术（n = 3，1.68%），其中大部分发生在气管（n = 173，96.65%）。TAS患者主要接受介入治疗（n = 168，93.85%）和支架植入（n = 47，26.26%）。BAS的肉芽组织主要表现为炎症、增殖和纤维化。IHC显示转化生长因子-β1（TGF-β1）、α-平滑肌肌动蛋白（α-SMA）、I型胶原蛋白（COL-I）和波形蛋白表达上调，E-钙黏蛋白表达下调，提示纤维化和上皮-间质转化（EMT）。
结核病是主要病因，创伤是次要病因。BAS的肉芽组织以炎症、纤维化和可能的EMT为特征。综合介入治疗是治疗BAS的有效方法。
