CHANGES IN MUCOCILIARY CLEARANCE DURING ACUTE EXACERBATIONS OF ASTHMA
CHANGES IN MUCOCILIARY CLEARANCE DURING ACUTE EXACERBATIONS OF ASTHMA
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DOI：
10.1164/ajrccm/143.5_pt_1.993
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发表时间：
1991-05-01
期刊：
影响因子：
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通讯作者：
SMALDONE, GC
中科院分区：
文献类型：
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作者：
MESSINA, MS;ORIORDAN, TG;SMALDONE, GC
以往的研究表明，哮喘患者的粘膜毛细血管清除(MC)功能受损。如果是这样的话，清除障碍可能是急性加重的重要因素。我们提出，如果MC在急性疾病中起重要作用，则MC在急性期应受到损害，但在恢复后应有所改善。为了验证这一假设，5名发作需要住院的哮喘患者接受了使用放射性标记气雾剂和伽马相机测量MC。在入院后第二天或第三天进行研究，出院后重复测量。所有研究前都进行了肺活量测定。在平衡氙气扫描(Xe-133)确定肺边界并测量区域体积后，沉积含有氚标记(99mTc)硫胶体的放射性标记盐水颗粒，并用于标记呼吸道粘液。通过调节颗粒分布和呼吸模式来匹配沉积模式。入院时，肺内初始放射性的96.0+/-2.06%(扫描电子显微镜)在2小时后仍保留在肺内，表明粘液几乎不能从肺中清除。事实上，当120分钟的活性与10分钟的测定值(99.2+/-0.22%，NS)进行比较时，没有检测到显著的变化。出院后清除量明显增加。也就是说，从10min开始，肺活动保留率在所有时间间隔都显著降低，120min时仅保留率为70.9+/-3.86%(p=0.008)。在哮喘发作需要入院期间，MC明显受损，康复后明显改善。虽然黏膜微血管损害与哮喘急性发作的临床特征之间的因果关系仍有待建立，但本文所显示的这种相关性表明，MC评估可能为评估患者哮喘的严重程度和对治疗的反应提供进一步的客观手段。
Previous studies have suggested that mucocillary clearance (MC) is impaired in asthmatic subjects. If so, impaired clearance may be an important factor in acute exacerbation. We proposed that if MC plays a significant role in acute illness, MC should be impaired during the exacerbation but improve after recovery. To test this hypothesis, five asthmatic patients with attacks requiring hospitalization underwent measurement of MC using radiolabeled aerosol and a gamma camera. They were studied on the second or third day after admission with repeat measurements after discharge. Spirometry was performed before all studies. After an equilibrium xenon scan (Xe-133), which defined lung borders and measured regional volume, radiolabeled saline particles containing technetium-labeled (99mTc) sulfur colloid were deposited and used to label airway mucus. Deposition patterns were matched by regulating particle distribution and breathing pattern. MC was then measured as percentage retention of radioactivity at 10-min intervals for 2 h. When hospitalized, 96.0 +/- 2.06% (SEM) of the initial radioactivity was retained in the lung after 2 h, indicating little clearance of mucus from the lung. In fact, no significant changes were detected when activity at 120 min was compared with measurements at 10 min (99.2 +/- 0.22%, NS). After discharge clearance was markedly enhanced. That is, retention of lung activity was significantly lower at all time intervals from 10 min onward, with only 70.9 +/- 3.86% retained at 120 min (p = 0.008). During an asthmatic attack warranting hospital admission, MC is significantly impaired, with marked improvement following recovery. Although a causal relationship remains to be established between mucocillary impairment and the clinical features of an acute exacerbation of asthma, the association demonstrated in this paper suggests that MC assessment may yet provide a further objective means of assessing the severity of a patient's asthma and the response to therapy.