Relationship between peripheral airway dysfunction, airway obstruction, and neutrophilic inflammation in COPD
Relationship between peripheral airway dysfunction, airway obstruction, and neutrophilic inflammation in COPD
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DOI：
10.1136/thx.2003.019349
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发表时间：
2004-10-01
期刊：
影响因子：
10
通讯作者：
Djukanovic, R
中科院分区：
文献类型：
--
作者：
O'Donnell, RA;Peebles, C;Djukanovic, R
背景：已经对慢性阻塞性肺疾病 (COPD) 气道炎症的性质进行了大量研究，但近端气道炎症与外周气道动态塌陷和 HRCT 确定的肺气肿严重程度之间的关系仍不清楚。已结合多种研究工具来研究根据 GOLD 标准分类的一系列 COPD 严重程度的吸烟者。方法：使用肺功能测试和 HRCT 扫描对 65 名受试者（11 名健康吸烟者、44 名 0 - IV 期 COPD 吸烟者和 10 名健康非吸烟者）进行评估，以量化肺气肿和外周气道功能障碍，并通过痰诱导来测量气道炎症。结果：呼气 HRCT 测量和与吸气 HRCT 测量（反映肺气肿严重程度；r = -0.45，p< 0.01）相比，吸烟者呼气/吸气平均肺密度比（外周气道功能障碍的两个指标）与气流阻塞严重程度的相关性更密切（r = -0.64，p < 0.001）。吸烟者痰中性粒细胞计数升高也与外周气道功能障碍的 HRCT 指标密切相关（r = 0.55，p< 0.001），但与肺气肿严重程度的 HRCT 指标无关。 结论：本研究表明，通过呼气 HRCT 测量评估的外周气道功能障碍是 COPD 严重程度的决定因素。气道中性粒细胞增多是 COPD 的一个核心特征，与 COPD 周围气道功能障碍的严重程度密切相关，但与 HRCT 测量的肺气肿的总体严重程度无关。
Background: Considerable research has been conducted into the nature of airway inflammation in chronic obstructive pulmonary disease ( COPD) but the relationship between proximal airways inflammation and both dynamic collapse of the peripheral airways and HRCT determined emphysema severity remains unknown. A number of research tools have been combined to study smokers with a range of COPD severities classified according to the GOLD criteria.Methods: Sixty five subjects ( 11 healthy smokers, 44 smokers with stage 0 - IV COPD, and 10 healthy nonsmokers) were assessed using lung function testing and HRCT scanning to quantify emphysema and peripheral airway dysfunction and sputum induction to measure airway inflammation.Results: Expiratory HRCT measurements and the expiratory/inspiratory mean lung density ratio ( both indicators of peripheral airway dysfunction) correlated more closely in smokers with the severity of airflow obstruction ( r = -0.64, p< 0.001) than did inspiratory HRCT measurements ( which reflect emphysema severity; r = -0.45, p< 0.01). Raised sputum neutrophil counts also correlated strongly in smokers with HRCT indicators of peripheral airway dysfunction ( r = 0.55, p< 0.001) but did not correlate with HRCT indicators of the severity of emphysema.Conclusions: This study suggests that peripheral airway dysfunction, assessed by expiratory HRCT measurements, is a determinant of COPD severity. Airway neutrophilia, a central feature of COPD, is closely associated with the severity of peripheral airway dysfunction in COPD but is not related to the overall severity of emphysema as measured by HRCT.