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目的用高分辨CT(HRCT)扫描测量支气管哮喘患者和嗜酸粒细胞性支气管炎(EB)患者段及亚段水平气道壁的厚度,评估支气管哮喘与EB的气道重构,探讨气道壁厚度与气道高反应性(AHR)的相关性。方法用HRCT扫描哮喘、EB、咳嗽变异型哮喘(CVA)患者和健康人共58例,测量右肺上叶尖段(RB1)支气管和能显示支气管横截面的内径为1～6 mm支气管的气道壁的内外径、内外腔面积,通过公式计算出气道壁厚度与外径之比(T/D);气道腔面积(AI);气道壁面积占气道总横截面积百分比(WA%)。测量值以平均体表面积(BSA)表示。结果 RB1和1～6 mm水平的气道壁T/D/BSA健康对照组(0.13±0.02,0.15±0.08)、EB组(0.16±0.07,0.15±0.06)、CVA组(0.16±0.06,0.16±0.08)、哮喘组(0.19±0.09,0.19±0.07),哮喘组较CVA组、EB组及健康对照组差异有统计学意义(P<0.05);RB1和1～6 mm水平的气道壁WA%各组数据从健康对照组(58.41±7.41,57.81±7.21)、EB组(64.67±7.32,64.34±6.32)、CVA组(65.27±6.72,65.37±6.52)及哮喘组(70.23±8.72,72.13±8.65)逐渐增加,哮喘组较CVA组、EB组及健康对照组差异有统计学意义(P<0.05);EB组T/D/BSA和WA%均较健康对照组显著增加,差异有统计学意义(P<0.05),与CVA组比较差异无统计学意义(P>0.05);说明EB患者也存在气道壁增厚,但明显轻于哮喘患者,与CVA患者气道壁厚度无显著性差异。RB1和1～6 mm水平的气道壁Al/BSA面积哮喘组(6.64±2.12,3.66±1.12)、CVA组(8.66±3.52,5.76±1.52)较健康对照组(11.04±4.12,7.44±2.12)明显减小(P<0.05),EB组(11.54±3.22,7.54±1.72)较健康对照组差异无统计学意义(P>0.05),说明EB患者不存在气道狭窄。结论 HRCT可测定气道壁厚度,评估患者气道重构。EB患者虽然存在一定程度的气道重构,但气道壁增厚显著低于哮喘患者,提示气道重构程度不足以产生气道高反应性。
Objective To measure the thickness of horizontal airway wall in patients with bronchial asthma and eosinophilic bronchitis (EB) by high resolution CT (HRCT) scan and assess the airway remodeling of bronchial asthma and EB, Correlation of wall thickness and airway hyperresponsiveness (AHR). Methods A total of 58 patients with asthma, EB, cough variant asthma (CVA) and healthy individuals were screened by HRCT. Bronchus in the right upper lobe segment (RB1) and bronchial airways with an inner diameter of 1-6 mm (T / D); Airway area (AI); Airway wall area to total airway cross-sectional area (WA) %). The measurements are expressed as mean body surface area (BSA). Results RB1 and T / D / BSA healthy group (0.13 ± 0.02,0.15 ± 0.08), EB group (0.16 ± 0.07,0.15 ± 0.06) and CVA group (0.16 ± 0.06, 0.16) ± 0.08), asthma group (0.19 ± 0.09,0.19 ± 0.07), asthma group than CVA group, EB group and healthy control group, the difference was statistically significant (P <0.05); RB1 and 1 ~ 6 mm level of the airway wall WA% The data of each group from the healthy control group (58.41 ± 7.41,57.81 ± 7.21), EB group (64.67 ± 7.32,64.34 ± 6.32), CVA group (65.27 ± 6.72,65.37 ± 6.52) and asthma group (70.23 ± 8.72, 72.13 ± 8.65), the difference was statistically significant (P <0.05) between the asthma group and CVA group, the EB group and the healthy control group; the T / D / BSA and WA% of the EB group were significantly higher than the healthy control group (P <0.05). There was no significant difference between CVA group and CVA group (P> 0.05). It also showed that airway wall thickening was also found in EB patients but was significantly lower than that in asthma patients Significant difference. RB1 and Al / BSA area of 1 ~ 6 mm in airway wall were significantly higher in asthma group (6.64 ± 2.12,3.66 ± 1.12), CVA group (8.66 ± 3.52,5.76 ± 1.52) than those in healthy control group (11.04 ± 4.12, 7.44 ± 2.12, ) (P <0.05). There was no significant difference between EB group (11.54 ± 3.22, 7.54 ± 1.72) and healthy control group (P> 0.05), which indicated that there was no airway stenosis in EB patients. Conclusion HRCT can measure the thickness of airway wall and evaluate the airway remodeling. Although there is a certain degree of airway remodeling in EB patients, airway wall thickening is significantly lower than that in asthma patients, suggesting that airway remodeling is not sufficient to produce airway hyperresponsiveness.