Nagai A, West W W, Paul J L, Thurlbeck W M
Am Rev Respir Dis. 1985 Nov;132(5):937-45. doi: 10.1164/arrd.1985.132.5.937.
We examined the lungs from 48 autopsied patients in the National Institutes of Health Intermittent Positive-Pressure Breathing trial who had moderately severe and severe chronic airflow obstruction. Compared with control patients without heart or lung disease, IPPB patients had mucous gland enlargement and increased muscle and decreased cartilage in bronchi. Most patients had severe emphysema. The bronchioles were narrower and more irregular in shape than in the control subjects. Bronchiolar inflammation, increased muscle and goblet cell metaplasia were moderately severe. Bronchioles had a higher proportion of muscle in younger control subjects than they did in older control subjects. A wide variation in severity of lesions in bronchi and bronchioles was observed. Correlations between lesions were of relatively low order. Mucous gland enlargement was negatively related to one measurement of emphysema and negatively related to bronchial eosinophilia. Mucous gland enlargement was not related to bronchial or bronchiolar inflammation or to bronchiolar narrowing. Emphysema was associated with decreased central airway muscle, decreased bronchial eosinophilia, increased bronchiolar narrowing, and distortion in the shape of bronchiolar lumens. Interrelationships between bronchiolar lesions were primarily between measurements of dimensions, and there was no relationship between bronchiolar narrowing and bronchiolar inflammation or fibrosis. Bronchiolar muscle was positively related to regularity of bronchiolar shape. We conclude that although lesions in the bronchi and bronchioles and parenchyma (emphysema) are easily demonstrable in patients with moderate and severe chronic air-flow obstruction, they vary widely in severity. The interrelationships are not strong, suggesting that relationships are due to a common etiologic agent, tobacco smoke.(ABSTRACT TRUNCATED AT 250 WORDS)
我们检查了美国国立卫生研究院间歇性正压通气试验中48例经尸检的患者的肺部，这些患者患有中度至重度慢性气流阻塞。与无心脏病或肺病的对照患者相比，间歇性正压通气患者的黏液腺增大，支气管中的肌肉增加而软骨减少。大多数患者有严重的肺气肿。细支气管比对照受试者更狭窄且形状更不规则。细支气管炎症、肌肉增加和杯状细胞化生为中度严重。与老年对照受试者相比，年轻对照受试者的细支气管中肌肉比例更高。观察到支气管和细支气管病变严重程度存在广泛差异。病变之间的相关性相对较低。黏液腺增大与一项肺气肿测量呈负相关，与支气管嗜酸性粒细胞增多呈负相关。黏液腺增大与支气管或细支气管炎症或细支气管狭窄无关。肺气肿与中央气道肌肉减少、支气管嗜酸性粒细胞增多减少、细支气管狭窄增加以及细支气管腔形状扭曲有关。细支气管病变之间的相互关系主要存在于尺寸测量之间，细支气管狭窄与细支气管炎症或纤维化之间没有关系。细支气管肌肉与细支气管形状的规则性呈正相关。我们得出结论，尽管在中度和重度慢性气流阻塞患者中，支气管、细支气管和实质（肺气肿）中的病变很容易被发现，但它们的严重程度差异很大。相互关系并不紧密，这表明这些关系是由一种共同的病因，即烟草烟雾引起的。（摘要截短至250字）
