Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States.
Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, United States.
J Appl Physiol (1985). 2024 Nov 1;137(5):1168-1174. doi: 10.1152/japplphysiol.00573.2024. Epub 2024 Sep 19.
Coronavirus disease 2019 (COVID-19) is associated with enlarged luminal areas of large conducting airways. In 10-30% of patients with acute COVID-19 infection, symptoms persist for more than 4 wk (referred to as post-acute sequelae of COVID 19, or PASC), and it is unknown if airway changes are associated with this persistence. Thus, we aim to investigate whether luminal area of large conducting airways is different between patients with PASC and COVID-19 and healthy controls. In this retrospective case-control study, 75 patients with PASC (48 females) were age-, height-, and sex-matched to 75 patients with COVID-19 and 75 healthy controls. Using three-dimensional digital reconstruction from computed tomography imaging, we measured luminal areas of seven conducting airways, including trachea, right and left main bronchi, bronchus intermediate, right and left upper lobe, and left lower lobe bronchi. Kruskal-Wallis H test was used to compare measurements between the three groups, as appropriate. Airway luminal areas between COVID-19 and PASC groups were not different (all, > 0.66). There were no group differences in airway luminal area (PASC vs. control) for trachea and right main bronchus. However, in the remaining five airways, airway luminal areas were 12-39% larger among patients with PASC than in controls (all, < 0.05). Patients diagnosed with COVID-19 and PASC have greater airway luminal area in most large conducting airways compared with healthy controls. No differences in luminal area between patients with COVID-19 and PASC suggest persistence of changes or insufficient time for reversal of changes. Three-dimensional reconstruction of airways has shown increased luminal area in patients with COVID-19 and post-acute sequelae of COVID-19 when compared with healthy controls. These findings suggest the role of large conducting airways in the pathogenesis of post-acute sequelae of COVID 19.
新型冠状病毒病 2019（COVID-19）与大导气管道的管腔区域扩大有关。在 10-30%的急性 COVID-19 感染患者中，症状持续超过 4 周（称为 COVID-19 的急性后遗症，或 PASC），目前尚不清楚气道变化是否与此持续性相关。因此，我们旨在研究 PASC 患者与 COVID-19 患者和健康对照者之间大导气管道的管腔区域是否存在差异。在这项回顾性病例对照研究中，我们将 75 名 PASC 患者（48 名女性）与 75 名 COVID-19 患者和 75 名健康对照者按年龄、身高和性别进行匹配。我们使用来自计算机断层扫描成像的三维数字重建来测量七个导气管道的管腔区域，包括气管、左右主支气管、中间支气管、左右上叶支气管和左下叶支气管。适当情况下，使用 Kruskal-Wallis H 检验比较三组之间的测量值。COVID-19 组和 PASC 组之间的气道管腔区域没有差异（均， > 0.66）。气管和右主支气管的气道管腔区域在 PASC 组与对照组之间没有差异。然而，在其余五个气道中，PASC 患者的气道管腔区域比对照组大 12-39%（均， < 0.05）。与健康对照组相比，COVID-19 患者和 PASC 患者的大多数大导气管道的气道管腔区域更大。COVID-19 患者和 PASC 患者的管腔区域无差异表明变化持续存在或变化逆转时间不足。气道的三维重建显示，与健康对照组相比，COVID-19 患者和 COVID-19 急性后遗症患者的气道管腔面积增加。这些发现表明大导气管道在 COVID-19 急性后遗症的发病机制中的作用。
