吸烟者肺小气道病理形态学半定量化标准研究及其与肺功能相关性研究

Study on criterion for classifing and quantitating the pathomorphologic changes in the smoker′s small airways

目的观察吸烟者小气道病理形态学变化,探讨小气道炎症病变与肺功能的相关性;建立新的肺小气道病理损伤定性指标半定量化标准.方法吸烟者肺手术标本灌注固定、矢状位取材、常规染色制片,以图像分析软件观察测量9项病理形态学指标,根据各项病理指标半定量化标准分别计分.结果小气道管壁结缔组织数量的病理得分占最高预计值比及阳性率与一秒钟用力呼气量占用力肺活量百分率(FEV1/FVC%)、一秒钟用力呼气量占预计值百分比(FEV1%pred)、最大通气量占预计值百分比(MVV%pred)、用力呼气中段流量占预计值百分比(FEF25%～75%pred)皆呈负相关性(P＜0.05);管腔狭窄、阻塞的病理得分占最高预计值比与MVV%pred呈负相关(r=-0.4085,P＜0.05),与残气量占肺总量预计值百分比(RV/TLC%pred)呈正相关(r=0.5467,P＜0.05).小气道管腔的狭窄、阻塞与杯状细胞化生(r=0.5268 P＜0.05)及结缔组织增生(r=0.8045,P＜0.001)有显著相关性.结论小气道炎症变化是引起小气道功能和肺通气功能障碍的重要原因,进一步证实了小气道炎症病变在吸烟者慢性阻塞性肺疾病发病早期肺小气道功能损害机制中的重要性.标化后的病理损伤定性指标定量化标准较经典法客观、敏感,更具合理性和可行性.

Objective To observe the relationship between the smokers＇ small airways inflammatory patho logical changes and pulmonary function and to set up new criteria for quantitating the pathological changes in the small airways. Methods The lungs of 13 surgical cases of smoker were fixed in 10% formalin, with an intra air way inflation pressure 25 cm H2 O maintained for 24-48 h. The pathological changes of the small airways were ex amined and quantitated using the microscopic morphometry software. To compare the new criteria for quantitating the pathological changes with the classical criteria. Results The degree of inflammatory cell infiltration, the amount of connective-tissue in the small airways and the degree of occlusion of the airway lumen correlated obvl ously with several indices of pulmonary function test. Conclusions Small airway inflammatory changes are tbe main causes for functional disorder and pulmonary ventilation deterioration, explaining the mechanism of early respiratory dysfuncton of COPD（chronic obstructive pulmonary disease） smorkers which are closely correlated with the morphologic changes in tern with new classification and quantition. （Shanghai Med J, 2005,28：1007-1009）