支气管哮喘和嗜酸粒细胞性支气管炎患者气道壁厚度的CT比较研究  

High Resolution Computed Tomographic Assessment of Airway Wall Thickness in Patients with Bronchial Asthma and Eosinophilic Bronchitis

作　　者：王娇莉[1] 任振义[1] 杨斌[2] 黄晟[1] 王利民[1] 叶健[1] 夏俊波[1] 

机构地区：[1]杭州市第一人民医院呼吸科,浙江杭州310006 [2]杭州市第一人民医院放射科,浙江杭州310006

出　　处：《中国呼吸与危重监护杂志》2011年第2期126-129,共4页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：杭州市科技发展计划资助项目(编号:20080333B04);杭州市医药卫生科技计划项目(编号:2008B0001)

摘　　要：目的用高分辨CT(HRCT)扫描测量支气管哮喘患者和嗜酸粒细胞性支气管炎(EB)患者段及亚段水平气道壁的厚度,评估支气管哮喘与EB的气道重构,探讨气道壁厚度与气道高反应性(AHR)的相关性。方法用HRCT扫描哮喘、EB、咳嗽变异型哮喘(CVA)患者和健康人共58例,测量右肺上叶尖段(RB1)支气管和能显示支气管横截面的内径为1～6 mm支气管的气道壁的内外径、内外腔面积,通过公式计算出气道壁厚度与外径之比(T/D);气道腔面积(AI);气道壁面积占气道总横截面积百分比(WA%)。测量值以平均体表面积(BSA)表示。结果 RB1和1～6 mm水平的气道壁T/D/BSA健康对照组(0.13±0.02,0.15±0.08)、EB组(0.16±0.07,0.15±0.06)、CVA组(0.16±0.06,0.16±0.08)、哮喘组(0.19±0.09,0.19±0.07),哮喘组较CVA组、EB组及健康对照组差异有统计学意义(P<0.05);RB1和1～6 mm水平的气道壁WA%各组数据从健康对照组(58.41±7.41,57.81±7.21)、EB组(64.67±7.32,64.34±6.32)、CVA组(65.27±6.72,65.37±6.52)及哮喘组(70.23±8.72,72.13±8.65)逐渐增加,哮喘组较CVA组、EB组及健康对照组差异有统计学意义(P<0.05);EB组T/D/BSA和WA%均较健康对照组显著增加,差异有统计学意义(P<0.05),与CVA组比较差异无统计学意义(P>0.05);说明EB患者也存在气道壁增厚,但明显轻于哮喘患者,与CVA患者气道壁厚度无显著性差异。RB1和1～6 mm水平的气道壁Al/BSA面积哮喘组(6.64±2.12,3.66±1.12)、CVA组(8.66±3.52,5.76±1.52)较健康对照组(11.04±4.12,7.44±2.12)明显减小(P<0.05),EB组(11.54±3.22,7.54±1.72)较健康对照组差异无统计学意义(P>0.05),说明EB患者不存在气道狭窄。结论 HRCT可测定气道壁厚度,评估患者气道重构。EB患者虽然存在一定程度的气道重构,但气道壁增厚显著低于哮喘患者,提示气道重构程度不足以产生气道高反应性。Objective To determine the airway wall thickness at the segmental and subsegmental levels in patients with bronchial asthma and eosinophilic bronchitis(EB) by high resolution CT scanning,and evaluate its relationship with airway hyperresponsiveness.Methods High resolution CT scanning was performed in 14 subjects with asthma,15 subjects with EB,15 subjects with cough variant asthma(CVA),and 14 healthy volunteers.Total airway and lumen diameter,total airway cross sectional area and lumen area which corrected by body surface area(BSA) were measured.The percentage of airway wall area to total airway cross sectional area(WA%) and wall thickness to airway diameter ratio(T/D) were calculated for the right upper lobe apical segmental bronchus(RB1) and all airways clearly visualized with a transverse diameter of 1-6 mm.Results T/D/BSA and WA% in the asthma patients were all significantly higher than those in the subjects with EB,CVA and healthy volunteers.T/D/BSA and WA% in the EB patients were significantly higher than the healthy volunteers,and similar with the CVA patients.Al/BSA in the patients with asthma and CVA was less than the subjects with EB and the healthy volunteers.However,Al/BSA in the EB patients was similar with the healthy volunteers.Conclusions The airway wall thickness and remodeling can be measured and assessed by high resolution CT.Airway wall thickness and remodeling in EB patients are milder than asthma patients,which may be associated with airway hyperresponsiveness that presents in asthma but not in EB.

关 键 词：哮喘 嗜酸粒细胞性支气管炎 高分辨CT 气道壁厚度 

分 类 号：R562.25[医药卫生—呼吸系统] R562.21[医药卫生—内科学]