Munakata M, Ohe M, Homma Y, Kawakami Y
First Department of Medicine, School of Medicine, Hokkaido University, Sapporo, Japan.
Respirology. 1997 Jun;2(2):113-8. doi: 10.1111/j.1440-1843.1997.tb00063.x.
Whether the disproportional growth of airways relative to lung parenchyma (dysanapsis) has any relationship to the development of non-specific bronchial hyperresponsiveness and atopy was investigated in 45 family members of the patients with atopic asthma. As indices of pulmonary dysanapsis, forced expiratory flow25-75/forced vital capacity (FEF25-75/FVC) and the tracheal cross sectional area divided by the forced expiratory volume (X-SA/FVC) were examined. As an index of non-specific airway responsiveness, the cumulative dose of inhaled methacholine needed to induce 35% reduction of respiratory conductance (PD35) was determined by continuous respiratory resistance measurement. For examination of atopy, skin prick tests were conducted, and total serum IgE and IgE specific to common inhaled antigens were measured. FEF25-75/FVC showed no significant correlation to FVC but showed a significant correlation to log(PD35). When the analysis was done in the subjects whose FEV1/FVC was more than 0.8, FEF25-75/FVC showed a significant negative correlation to FVC but lost its correlation to log(PD35). X-SA/FVC showed a significant negative correlation to FVC but had no significant correlation to log(PD35). These relations were conserved when the analysis was done in subjects without airway obstruction. In addition, FEV1/FVC had a significant correlation to log(PD35) and FEF25-75/FVC. However, subjects who had a positive IgE(MAST) had a significantly smaller X-SA/FVC than those with a negative IgE(MAST) (0.60 +/- 0.14[SD] and 0.72 +/- 0.18, respectively, P < 0.02). These results suggest that although pulmonary dysanapsis does not have a significant relation to airway responsiveness to inhaled methacholine, it may be associated with sensitization to airborne antigens.
在45名特应性哮喘患者的家庭成员中，研究了气道相对于肺实质的不成比例生长（发育异常）是否与非特异性支气管高反应性和特应性的发展存在任何关系。作为肺发育异常的指标，检测了用力呼气流量25%-75%/用力肺活量（FEF25-75/FVC）以及气管横截面积除以用力呼气量（X-SA/FVC）。作为非特异性气道反应性的指标，通过连续呼吸阻力测量来确定诱导呼吸传导率降低35%所需的吸入乙酰甲胆碱的累积剂量（PD35）。为了检测特应性，进行了皮肤点刺试验，并测量了总血清IgE和对常见吸入性抗原特异性的IgE。FEF25-75/FVC与FVC无显著相关性，但与log(PD35)呈显著相关性。当对FEV1/FVC大于0.8的受试者进行分析时，FEF25-75/FVC与FVC呈显著负相关，但与log(PD35)的相关性消失。X-SA/FVC与FVC呈显著负相关，但与log(PD35)无显著相关性。在无气道阻塞的受试者中进行分析时，这些关系依然存在。此外，FEV1/FVC与log(PD35)和FEF25-75/FVC有显著相关性。然而，IgE(MAST)阳性的受试者的X-SA/FVC显著小于IgE(MAST)阴性的受试者（分别为0.60±0.14[标准差]和0.72±0.18，P<0.02）。这些结果表明，尽管肺发育异常与气道对吸入乙酰甲胆碱的反应性无显著关系，但可能与对空气传播抗原的致敏有关。
