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细支气管周围化生:农村队列中香烟烟雾诱导的小气道损伤的标志物

Peribronchiolar Metaplasia: A Marker of Cigarette Smoke-Induced Small Airway Injury in a Rural Cohort.

作者信息

Sangani Rahul G, Deepak Vishal, Ghio Andrew J, Patel Zalak, Alshaikhnassir Esra, Vos Jeffrey

机构信息

Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, West Virginia University, Morgantown, WV, USA.

US EPA, Chapel Hill, NC, USA.

出版信息

Clin Pathol. 2023 Nov 9;16:2632010X231209878. doi: 10.1177/2632010X231209878. eCollection 2023 Jan-Dec.

Abstract

BACKGROUND

Peribronchiolar metaplasia (PBM) is considered a reaction to injury characterized by the proliferation of bronchiolar epithelium into immediately adjacent alveolar walls. While an association of PBM with diffuse interstitial lung diseases has been recognized, the clinical significance of PBM remains uncertain.

METHODS

A cohort (n = 352) undergoing surgical resection of a lung nodule/mass in a rural area was retrospectively reviewed. Multivariate logistic regression analysis was performed to determine the association of PBM with clinical, physiological, radiographic, and histologic endpoints.

RESULTS

In the total study cohort, 9.1% were observed to have PBM as a histologic finding in resected lung tissue (n = 32). All but one of these patients with PBM were ever-smokers with a median of 42 pack years. Clinical COPD was diagnosed in two-thirds of patients with PBM. Comorbid gastroesophageal reflux disease (GERD) was significantly associated with PBM. All patients with PBM demonstrated radiologic and histologic evidence of emphysema. Measures of pulmonary function were not impacted by PBM. Mortality was not associated with the histologic observation of PBM. In a logistic regression model, centrilobular-ground glass opacity interstitial lung abnormality and traction bronchiectasis on the CT scan of the chest and histologic evidence of fibrosis, desquamative interstitial pneumonia and anthracosis all strongly predicted PBM in the cohort.

CONCLUSION

A constellation of radiologic and histologic smoking-related abnormalities predicted PBM in study cohort. This confirms a co-existence of lung tissue responses to smoking including PBM, emphysema, and fibrosis. Acknowledging the physiologically "silent" nature of small airway dysfunction on pulmonary function testing, our findings support PBM as a histologic marker of small-airway injury associated with cigarette smoking.

摘要

背景

细支气管周围化生(PBM)被认为是一种对损伤的反应,其特征是细支气管上皮增生并延伸至紧邻的肺泡壁。虽然PBM与弥漫性间质性肺疾病的关联已得到认可,但其临床意义仍不明确。

方法

回顾性分析了一个农村地区行肺结节/肿块手术切除的队列(n = 352)。进行多因素逻辑回归分析以确定PBM与临床、生理、影像学和组织学终点之间的关联。

结果

在整个研究队列中,9.1%的患者在切除的肺组织中存在PBM这一组织学表现(n = 32)。除1例患者外,所有这些PBM患者均为曾经吸烟者,吸烟史中位数为42包年。三分之二的PBM患者被诊断为临床慢性阻塞性肺疾病(COPD)。合并胃食管反流病(GERD)与PBM显著相关。所有PBM患者均有肺气肿的影像学和组织学证据。肺功能指标未受PBM影响。死亡率与PBM的组织学观察无关。在逻辑回归模型中,胸部CT扫描显示的小叶中心磨玻璃影间质性肺异常、牵拉性支气管扩张以及纤维化、脱屑性间质性肺炎和炭末沉着症的组织学证据均强烈预测队列中的PBM。

结论

一系列与吸烟相关的影像学和组织学异常可预测研究队列中的PBM。这证实了肺组织对吸烟的反应包括PBM、肺气肿和纤维化并存。鉴于肺功能测试中小气道功能障碍在生理上“无症状”的特点,我们的研究结果支持PBM作为与吸烟相关的小气道损伤的组织学标志物。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/687a/10638866/a6eb4665dde1/10.1177_2632010X231209878-fig1.jpg

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