支气管热成形术对重症支气管哮喘患者气道重塑、哮喘控制水平和生活质量的影响

Effects of bronchial thermoplasty on airway remodeling,asthma control and quality of life in patients with severe asthma

目的:探讨支气管热成形术(BT)对重症支气管哮喘(简称哮喘)患者气道重塑、哮喘控制水平和生活质量的影响。方法:2019年1—9月在中日友好医院招募入组11例重症哮喘患者接受BT治疗。治疗分3次进行,间隔3周,依次治疗右肺下叶、左肺下叶及双肺上叶。本研究采用患者自身对照法,对治疗前后有关指标进行比较。组织学染色检测两组左肺下叶气道重塑情况,包括气道平滑肌(ASM)、胶原蛋白在气道壁中的质量占比和基底膜厚度;临床检测评估两组左肺下叶支气管肺泡灌洗液(BALF)细胞分类计数、外周血细胞分类计数、血清总IgE、哮喘控制测试(ACT)、简易版哮喘生活质量调查问卷(miniAQLQ)和第一秒用力呼气容积占预计值的百分比(FEV 1%预计值);分析气道重塑与哮喘控制水平和生活质量等方面的相关性。结果:BT治疗后与治疗前相比:ASM质量占比、胶原蛋白质量占比均显著降低[(9.8±2.5)%比(25.8±7.7)%、(12.9±4.0)%比(17.4±5.6)%](均P<0.05),基底膜厚度差异无统计学意义(P>0.05);BALF嗜酸粒细胞百分比、外周血嗜酸粒细胞百分比和血清总IgE差异均无统计学意义(均P>0.05);ACT评分和miniAQLQ评分均显著提高[(23.1±1.8)比(13.8±6.2)分、(5.3±1.3)比(3.6±1.5)分](均P<0.05),FEV 1%预计值差异无统计学意义(P>0.05)。ASM质量占比与ACT评分、miniAQLQ评分、FEV 1%预计值均呈负相关(r=-0.712、-0.557、-0.477,均P<0.05);胶原蛋白质量占比与ACT评分、miniAQLQ评分均呈负相关(r=-0.549、-0.639,均P<0.05)。结论:BT可改善重症哮喘患者气道重塑,提高患者哮喘控制水平和生活质量,气道重塑改善与哮喘控制水平及生活质量的提高存在相关性。

Objective To investigate the effects of bronchial thermoplasty(BT)on airway remodeling,asthma control and quality of life in patients with severe asthma.Methods From January to September 2019,11 patients with severe asthma were recruited from China Japan Friendship Hospital to receive BT treatment.The treatment was performed over three sessions separated by 3-week intervals.The right lower lobe,the left lower lobe and the bilateral upper lobes were treated respectively.In this study,patients′self-control method was used.The timepoint before the first BT treatment was defined as pre-treatment group,and the timepoint before the third treatment was defined as post-treatment group.Histological staining was used to detect the airway remodeling of the left lower lobe in two groups,including the mass of airway smooth muscle(ASM)and collagen in airway wall,and the thickness of basement membrane.The cell classification of bronchoalveolar lavage fluid(BALF)from the left lower lobe and peripheral blood,total serum IgE,asthma control test(ACT),mini asthma quality of life questionnaire(miniAQLQ)and the forced expiratory volume in 1 second expressed as percent predicted(FEV1%pred)were evaluated in the two groups.The correlation was analyzed between airway remodeling and asthma control and quality of life.Results Effects of BT in post-treatment group,compared with pre-treatment group:the mass of ASM and collagen in airway wall was significantly decreased[(9.8±2.5)%vs(25.8±7.7)%,(12.9±4.0)%vs(17.4±5.6)%](both P<0.05),while basement membrane thickness was not significantly different(P>0.05);the percentage of eosinophils in BALF and peripheral blood,and total serum IgE were not significantly different(all P>0.05);ACT score and miniAQLQ score were significantly increased[(23.1±1.8)vs(13.8±6.2)points,(5.3±1.3)vs(3.6±1.5)points](both P<0.05),while FEV1%pred was not statistically different(P>0.05).The mass of ASM was negatively correlated with ACT score(r=-0.712),miniAQLQ score(r=-0.557)and FEV1%pred(r=-0.477),while the mass of collagen was negatively correlated with ACT score(r=-0.549)and miniAQLQ score(r=-0.639)(all P<0.05).Conclusion BT treatment could improve airway remodeling,asthma control and quality of life in patients with severe asthma;besides,the reduction of remodeling is related to the improvements of asthma control and quality of life.