四维自动左房定量技术评估冠心病患者左房容积及功能的临床价值

目的 应用四维超声心动图（4DE）的左房定量技术评估冠心病（CHD）患者左房容积及应变的改变情况。方法 选取我院临床疑诊为CHD且二维超声心动图（2DE）未发现节段性室壁运动异常（RWMA）的住院患者62例，根据冠状动脉造影（CAG）结果分为CHD组41例和对照组21例，均于CAG术前行2DE获取左房前后径（LAD）、左室射血分数（LVEF）、二尖瓣口舒张早期峰值血流速度（E）与二尖瓣环舒张早期峰值位移速度（e）之比（E/e）, 4DE获取左房最小容积（LAVmin）、左房最大容积（LAVmax）、左房最小容积指数（LAVImin）、左房最大容积指数（LAVImax）、左房收缩期前容积（LAVApre）、左房射血容积（LAEV）、左房射血分数（LAEF），左房储备、管道、辅泵期纵向应变（LASr、LAScd、LASct）及环向应变（LASr_c、LAScd_c、LASct_c）；比较两组一般资料和各超声心动图参数的差异。绘制受试者工作特征曲线（receiver operating characteristic，ROC）评价4DE参数对CHD的诊断价值。根据CAG结果进一步将CHD组分为LCX累及组和非LCX累及组，比较两组各超声心动图参数的差异。采用组内相关系数（ICC）检验各超声心动图参数的重复性。结果 CHD组与对照组一般资料和各2DE参数比较，差异均无统计学意义；与对照组比较，CHD组LAVmin、LAVImin均增大，LAEF、LASr、LASr_c、LAScd_c、LASct_c均减小，差异均有统计学意义（均P＜0.05）。ROC曲线分析显示，LASr_c以＜33.5%为截断值，诊断CHD的灵敏度为90.2%，特异度为71.4%，曲线下面积为0.891。LCX累及组与非LCX累及组各超声心动图参数比较，差异均无统计学意义。重复性检验显示，各2DE和4DE参数在观察者内和观察者间的重复性良好（ICC均＞0.640）。结论 应用4DE左房定量技术可准确评估CHD患者左房容积和应变改变情况，其中LASr_c对CHD患者的诊断效能最佳，有一定的临床价值。     

Differential role of mucus plugs in asthma: Effects of smoking and association with airway inflammation

BackgroundThe physiological importance of mucus plugs in computed tomography (CT) imaging is being increasingly recognized. However, whether airway inflammation and smoking affect the association between mucus plugs and clinical–physiological outcomes in asthma remains to be elucidated. The objective of this study is to examine how airway inflammation and/or smoking affect the correlation of CT-based mucus plug scores with exacerbation frequency and airflow limitation indices in asthma.MethodsA total of 168 patients with asthma who underwent chest CT and sputum evaluation were enrolled and classified in eosinophilic asthma (EA; n = 103) and non-eosinophilic asthma (NEA; n = 65) groups based on sputum eosinophil percentage (cut-off: 3%). The mucus plug score was defined as the number of lung segments with mucus plugs seen on CT.ResultsMore mucus plugs were detected on CT scans in the EA group than in the NEA group, regardless of smoking status. Mucus plug score and exacerbation frequency during one year after enrollment were significantly associated in the EA group but not in the NEA group after adjusting for demographics, blood eosinophil count, and fractional exhaled nitric oxide. Mucus plug score was associated with percentage of predicted forced expiratory volume in 1 s in non-smoking individuals in the EA and NEA group and in smoking individuals in the EA group but not in the NEA group after adjusting for demographics.ConclusionsThe association of mucus plug score with exacerbation frequency and reduced lung function may vary due to airway inflammatory profile and smoking status in asthma.