哮喘患者的肺血管系统修剪:重症哮喘研究计划(SARP)队列

2018/11/02

   摘要
   背景:外周肺血管系统的丧失,称为血管修剪,与慢性阻塞性肺疾病患者的疾病严重程度相关。本文旨在明确肺血管修剪是否与哮喘疾病严重程度和恶化相关。
   方法:利用非对比计算机断层扫描,我们测量了来自重症哮喘研究计划的参与者的总肺血管容积(TBV),横截面积(BV5)小于5 mm2的血管容积和横截面积小于10 mm2(BV10)的血管容积。BV5与TBV的比值(BV5/TBV)和BV10与TBV的比值(BV10/TBV)降低提示血管修剪(外周肺血管系统的丧失)。
   结果:与健康对照组相比,重症哮喘患者的肺血管修剪更多。在哮喘患者中,哮喘控制不佳的患者比控制良好的患者血管修剪更多。肺血管系统的修剪也与较低的FEV1/FVC%预测值,外周血和痰嗜酸性粒细胞增多,以及BAL血清淀粉样蛋白A/脂氧素A4比率升高相关,但与低衰减区域或痰中性粒细胞无关。与低修剪个体相比,最高血管修剪个体被报告哮喘急性发作的几率高出150%(比值比为2.50;置信区间为1.05-5.98;BV10/TBV的P值为0.039),随访期间哮喘恶化率增加45%(发病率比率为1.45;置信区间为1.02-2.06;BV10/TBV的P值为0.036)。
   结论:外周肺血管系统修剪与哮喘严重程度,控制和恶化以及肺功能和嗜酸性粒细胞增多有关。

 
(中日友好医院呼吸与危重症医学科 王瑞茵 摘译 林江涛 审校)
(Am J Respir Crit Care Med. 2018 Jul 1;198(1):39-50. doi: 10.1164/rccm.201712-2426OC.)
 
 
 
Pruning of the Pulmonary Vasculature in Asthma. The Severe Asthma Research Program (SARP) Cohort..
 
Ash SY, Rahaghi FN, Come CE, Ross JC, Colon AG, Cardet-Guisasola JC, Dunican EM, Bleecker ER, Castro M, Fahy JV, Fain SB, Gaston BM, Hoffman EA, Jarjour NN, Mauger DT, Wenzel SE, Levy BD, San Jose Estepar R, Israel E, Washko GR; SARP Investigators..
 
Abstract
BACKGROUND:Loss of the peripheral pulmonary vasculature, termed vascular pruning, is associated with disease severity in patients with chronic obstructive pulmonary disease. To determine if pulmonary vascular pruning is associated with asthma severity and exacerbations.
METHODS:We measured the total pulmonary blood vessel volume (TBV) and the blood vessel volume of vessels less than 5 mm2 in cross-sectional area (BV5) and of vessels less than 10 mm2 (BV10) in cross-sectional area on noncontrast computed tomographic scans of participants from the Severe Asthma Research Program. Lower values of the BV5 to TBV ratio (BV5/TBV) and the BV10 to TBV ratio (BV10/TBV) represented vascular pruning (loss of the peripheral pulmonary vasculature).
RESULTS:Compared with healthy control subjects, patients with severe asthma had more pulmonary vascular pruning. Among those with asthma, those with poor asthma control had more pruning than those with well-controlled disease. Pruning of the pulmonary vasculature was also associated with lower percent predicted FEV1 and FVC, greater peripheral and sputum eosinophilia, and higher BAL serum amyloid A/lipoxin A4 ratio but not with low-attenuation area or with sputum neutrophilia. Compared with individuals with less pruning, individuals with the most vascular pruning had 150% greater odds of reporting an asthma exacerbation (odds ratio, 2.50; confidence interval, 1.05-5.98; P = 0.039 for BV10/TBV) and reported 45% more asthma exacerbations during follow-up (incidence rate ratio, 1.45; confidence interval, 1.02-2.06; P = 0.036 for BV10/TBV).
CONCLUSIONS:Pruning of the peripheral pulmonary vasculature is associated with asthma severity, control, and exacerbations, and with lung function and eosinophilia.




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