PULMONARY VASCULAR ABNORMALITIES AND VENTILATION-PERFUSION RELATIONSHIPS IN MILD CHRONIC OBSTRUCTIVE PULMONARY-DISEASE
PULMONARY VASCULAR ABNORMALITIES AND VENTILATION-PERFUSION RELATIONSHIPS IN MILD CHRONIC OBSTRUCTIVE PULMONARY-DISEASE
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DOI：
10.1164/ajrccm.149.2.8306040
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发表时间：
1994-02-01
影响因子：
24.7
通讯作者：
RODRIGUEZROISIN, R
中科院分区：
文献类型：
--
作者：
BARBERA, JA;RIVEROLA, A;RODRIGUEZROISIN, R
在慢性阻塞性肺疾病（COPD）患者中，肺肌性动脉的形态学变化可能会改变调节肺血管张力的机制，并有助于维持足够的通气-灌注（VA/Q）匹配。为了分析肺肌性动脉异常与VA/Q不等程度的关系，以及这些异常对吸氧引起的VA/Q关系改变的影响，我们研究了一组接受肺切除术的轻度COPD患者。根据气流阻塞的程度和100%O-2产生的VA/Q失配的增加，（Δ logSD Q），将患者分为三组：（A）肺功能正常的患者，（B）气流阻塞和对氧反应高的患者（A logSD Q > 0.4），和（C）具有气流阻塞和对氧气的低反应的患者（A logSD Q < 0.4）。B、C组肺动脉管腔较A组狭窄，管壁较A组增厚，主要表现为内膜增厚，C组较B组明显。对内膜面积与动脉直径的关系的评估表明，C组内膜的增加主要发生在直径较小（< 500 μ m）的动脉中。每例受试者的平均内膜面积与Pa-O2值（r =-0.46，p < 0.05）和VA/Q不匹配的总体指数（r = 0.51，p < 0.05）相关。我们的结论是，在轻度COPD患者的肺肌动脉内膜层的扩大与较高程度的VA/Q不等，和内膜增厚的小动脉似乎减少肺循环的反应，以不同的氧浓度。
Morphologic changes in pulmonary muscular arteries may modify the mechanisms that regulate the pulmonary vascular tone and contribute to maintaining an adequate ventilation-perfusion (VA/Q) matching in patients with chronic obstructive pulmonary disease (COPD). To analyze the relationships between the abnormalities of pulmonary muscular arteries and the degree of VA/Q inequality, and to assess the effect of these abnormalities on the changes in VA/Q relationships induced by oxygen breathing, we studied a group of patients with mild COPD undergoing resective lung surgery. According to the degree of airflow obstruction and the increase in VA/Q mismatch produced by 100% O-2, breathing (Delta logSD Q), patients were divided into three groups: (A) patients with normal lung function, (B) patients with airflow obstruction and a high response to oxygen (Delta logSD Q > 0.4), and (C) patients with airflow obstruction and a low response to oxygen (Delta logSD Q < 0.4). Pulmonary arteries in Groups B and C showed narrower lumens and thicker walls than in Group A, These morphologic changes were produced mainly by an enlargement of the intimal layer and were more pronounced in Group C than in Group B. The assessment of intimal area as a function of artery diameter showed that the increase in intima in Group C took place predominantly in arteries with small diameters (< 500 mu m). The mean intimal area on each subject correlated with both the Pa-O2 value (r = -0.46, p < 0.05) and the overall index of VA/Q mismatching (r = 0.51, p < 0.05). We conclude that in patients with mild COPD the enlargement of the intimal layer in pulmonary muscular arteries is associated with a higher degree of VA/Q inequality, and that intimal thickening in small arteries seems to reduce the response of the pulmonary circulation to different oxygen concentrations.