支气管热成形术对难治性哮喘患者肺功能、血嗜酸性粒细胞数及HRCT下管腔面积的影响

Effects of bronchialthermoplasty on lung function,blood eosinophil count,and lumen area under HRCT in patients with refractory asthma

目的评估支气管热成形术(bronchial thermoplasty, BT)对难治性哮喘(refractory asthma, RA)患者肺功能、血嗜酸性粒细胞(eosinophil, E)改变率和高分辨率CT(high resolution CT, HRCT)下管腔面积(lumen area, LA)的影响。方法入选同济大学附属第十人民医院26例RA患者,其中8例行BT治疗,18例行吸入激素和支气管扩张剂传统治疗,收集其临床资料,血常规,肺功能和HRCT下左右上叶尖段、左上叶固有段、左右下叶基底段和左右下叶后基底段支气管开口处支气管LA,比较两组的差异,分析小支气管LA改善率与肺功能改善率和术后嗜酸性粒细胞的相关性。结果与对照组比较,BT组FEV1/FVC(-0.188±0.123 vs-0.038±0.096)、FEV1(-0.263±0.146 vs-0.061±0.185)和FEV1%(-0.254±0.163 vs-0.050±0.169)负值明显减少,差异具有统计学意义(P均<0.05);BT组患者段支气管LA(0.008±0.157 vs 0.121±0.149)、小支气管LA(0.022±0.265 vs 0.176±0.311)、总支气管LA(0.015±0.224 vs 0.153±0.254)明显扩大,差异有统计学意义(P均<0.05);小支气管管腔面积改善率与术后血嗜酸性粒细胞值和百分比有负相关趋势,但差异无统计学意义(r=-0.108,P=0.798;r=-0.065,P=0.878)。结论 BT能够延缓RA患者的肺功能下降速度,明显扩张支气管LA,小支气管LA改善值与肺功能和嗜酸性粒细胞无相关性。

Objective To investigate the effects of bronchial thermoplasty(BT)on lung function,blood eosinophil(Eosinophil,E)changes,and the lower lumen area(LA)under high-resolution CT(high resolution CT,HRCT)in patients with refractory asthma(RA).Methods Twenty-six patients with RA were enrolled from the Tenth People s Hospital,Tongji University.Eight of them underwent BT therapy and 18 received traditional therapy with inhaled hormones and bronchodilators.The clinical data,blood routine,pulmonary function,and HRCT LA segments(bronchial opening of the left upper left lobe propria,the left and right lower lobe basal segments,and the left and right lower lobe basal segments)were collected.The changes of LA,lung function and eosinophil number after BT were analyzed.Results Compared with the control group,FEV 1/FVC(-0.188±0.123 vs-0.038±0.096),FEV 1(-0.263±0.146 vs-0.061±0.185),and FEV 1%(-0.254±0.163 vs-0.050±0.169)in patients after BT were more markedly improved(P<0.05).Compared with the control group,segmental bronchial LA(0.008±0.157 vs 0.121±0.149),small bronchial LA(0.022±0.265 vs 0.176±0.311)and the total bronchial LA(0.015±0.224 vs 0.153±0.254)in BT group was significantly enlarged(all P values were<0.05).The improvement rate of small LA was not correlated with postoperative blood E value and percentage(r=-0.108,P=0.798;r=-0.065,P=0.878).Conclusion Bronchial thermoplasty can delay the decline of lung function and significantly expand bronchial lumen area in refractory asthma patients.