Effects of Bronchial Thermoplasty on Airway Smooth Muscle and Collagen Deposition in Asthma
Effects of Bronchial Thermoplasty on Airway Smooth Muscle and Collagen Deposition in Asthma
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DOI：
10.1513/annalsats.201504-208oc
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发表时间：
2015-11-01
影响因子：
8.3
通讯作者：
Laviolette, Michel
中科院分区：
文献类型：
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作者：
Chakir, Jamila;Haj-Salem, Ikhlass;Laviolette, Michel
原理：支气管热成形术的目的是通过减少中央气道平滑肌质量来改善哮喘症状。到目前为止，只有一组10例患者的治疗前总支气管活检面积的15%或以上被平滑肌占据，平滑肌质量减少。目的：评价支气管热成形术对成人哮喘患者气道平滑肌质量和气道胶原沉积的影响，无论治疗前平滑肌面积如何。方法：17例哮喘患者在三次访视中接受了支气管热成形术。在访视1时，从本次治疗期间未接受治疗的下叶采集支气管活检。访视2时（首次访视后3-14周），所有17例患者均接受了首次手术期间治疗的下叶活检。在访视3（首次访视后7- 22周）时，9例患者同意接受同一下叶活检。测量和主要结果：支气管热成形术减少了气道平滑肌，从访视1时占总活检表面的12.9 ± 1.2%减少到访视2时的4.6 ± 0.8%（P < 0.0001）。对于接受第三次活检的9例患者，访视3时的平均气道平滑肌面积为5.3 ± 1.3%（与基线相比，P = 0.0008）。支气管热成形术也减少了基底膜下的I型胶原沉积，从第1次访视时的6.8 +/- 0.3 μ m减少到第2次访视时的4.3 +/- 0.2 μ m（P < 0.0001），9名患者在第3次访视时减少到4.4 +/- 0.4 μ m（与基线相比，P <0.0001）。在治疗后1年的过程中，吸入皮质类固醇的剂量、严重急性发作的次数和哮喘控制都有所改善（P
Rationale: The aim of bronchial thermoplasty is to improve asthma symptoms by reducing central airway smooth muscle mass. Up to now, the reduction of smooth muscle mass has been documented for only 1 group of 10 patients who had 15% or more of their pretreatment total bronchial biopsy area occupied by smooth muscle.Objectives: To evaluate the effects of bronchial thermoplasty on airway smooth muscle mass and airway collagen deposition in adult patients with asthma, regardless of pretreatment smooth muscle area.Methods: Seventeen patients with asthma underwent bronchial thermoplasty over the course of three visits. At Visit 1, bronchial biopsies were taken from the lower lobe that was not treated during this session. At Visit 2 (3-14 wk after the first visit), all 17 patients underwent biopsy of the lower lobe treated during the first procedure. At Visit 3 (7-22wk after the first visit), nine patients agreed to undergo biopsy of the same lower lobe. Histological and immunohistochemical analyses were performed on the biopsy specimens.Measurements and Main Results: Bronchial thermoplasty decreased airway smooth muscle from 12.9 +/- 1.2% of the total biopsy surface at Visit 1 to 4.6 +/- 0.8% at Visit 2 (P < 0.0001). For the nine patients who underwent a third biopsy, mean airway smooth muscle area was 5.3 +/- 1.3% at Visit 3 (P = 0.0008 compared with baseline). Bronchial thermoplasty also decreased Type I collagen deposition underneath the basement membrane from 6.8 +/- 0.3 mu m at Visit 1 to 4.3 +/- 0.2 mu m at Visit 2 (P < 0.0001) and to 4.4 +/- 0.4 mu m for nine patients at Visit 3 (P, 0.0001 compared with baseline). Over the course of 1 year after treatment, the doses of inhaled corticosteroid, the number of severe exacerbations, and asthma control all improved (P