HRCT定量评价哮喘和COPD患者气道壁厚度差异的研究

目的用HRCT测量支气管哮喘、慢性阻塞性肺病（COPD）患者及正常对照组的支气管管壁厚度,并评价两者的支气管壁厚度变化,初步探讨支气管哮喘和COPD患者气道重构的差异。方法用高分辨率CT（HRCT）扫描支气管哮喘患者35例,COPD患者30例,正常对照组20例。测量右肺上叶尖段支气管壁横截面的外径D和内径L,通过公式计算出支气管管壁厚度与外径比值（T/D）、管腔面积（Al）、气道壁面积（WA）及气道壁面积占气道总截面积百分比（WA%）。用统计软件SPSS的单因素方差分析统计三组之间观察指标的差异。结果支气管哮喘组和COPD组的支气管壁厚度均较正常对照组增厚,T/D、WA、WA%之间的差异均有统计学意义（P〈0.05,P〈0.05,P〈0.05）;支气管哮喘组支气管管腔较正常对照组未见明显狭窄（P〉0.05）,而COPD组支气管管腔面积较正常对照组减小（P〈0.05）。支气管哮喘组与COPD组比较,T/D、WA之间差异无统计学意义（P〉0.05）,而WA%之间的差异有统计学意义（P〈0.05）。COPD组较支气管哮喘组管腔面积减小,差异有统计学意义（P〈0.05）。结论相对于正常对照组,哮喘患者气道管壁面积增大而管腔面积不减小,而COPD患者气道管壁面积增大且同时管腔面积减小。不同的重构模式可反映哮喘和COPD患者炎症发展进程的根本区别。

Quantitative study on difference of airway wall thickness between bronchial asthma and COPD assessed by high-resolution CT

Objective To assess the difference of airway wall thickness between asthma and COPD by HRCT and preliminarily evaluate the difference of airway wall remodeling between them. Methods HRCT were performed in 35 asthmatic patients, 30 COPD patients and 20 healthy subjects. We measured total airway diameter (D) and lumen diameter (L) of upper lobe apical segmental bronchus of right lung, then calculated the airway wall thickness (T), wall thickness to airway diameter ratio (T/D), airway luminal area (Al), airway wall area (WA) and the percentage of airway wall area to total airway cross sectional area (WA%). The difference of these quantitive parameters (T/D, Al, WA, WA%) were analyzed by ANOVA from Statistical Package for the Social Science (SPSS) software. Results T/D, WA, WA% of asthma group and COPD group were significantly higher than that of healthy subjects group (P<0.05, P<0.05, P<0.05). While Al had no significant difference between asthma group and healthy subjects group (P>0.05) and Al of COPD group was lower than that of healthy subjects group (P<0.05). T/D, WA had no significant difference between asthma group and COPD group while WA%, Al of COPD group were significantly lower than that of asthma group (P<0.05). Conclusion Compared with the healthy subjects group, the airway wall thickness of asthma and COPD increas, while the airway luminal area of asthma does not decreased and that of COPD decreases significantly. The different pattern of remodeling may reflect fundamental differences in the inflammatory processes in asthma and COPD.