支气管热成形术治疗重症支气管哮喘的作用机制及临床应用的研究进展

Research progress on the mechanism and clinical application of bronchial thermoplasty in the treatment of severe bronchial asthma

支气管哮喘(哮喘)是临床上常见的一种慢性气管炎症性疾病,大多数患者通过规范使用药物可以得到有效控制或较好改善,但仍有部分重度哮喘患者尽管接受大剂量吸入皮质类固醇和长效β2受体激动剂的治疗仍然难以控制。支气管热成形术的诞生为解决这一问题提供了新的途径。支气管热成形术是通过支气管镜进入直径>3 mm的气道由远到近逐一进行射频消融,可有效减少气道平滑肌质量,改善哮喘症状,有效控制哮喘。全球哮喘防治倡议指南、欧洲呼吸学会/美国胸科学会指南均推荐支气管热成形术治疗重症哮喘。我国2014年正式批准将该技术用于临床。目前已有多家医院开展了这项技术,但其完整的作用机制及临床长期疗效仍是未来研究的重点。本文就支气管热成形术的作用机制、临床应用的有效性及安全性评估进行综述。

Bronchial asthma(asthma)is a commonly seen clinical chronic inflammatory disease of the airway.Most patients′symptoms can be effectively controlled or improved by standard use of drugs,but some severe symptoms are difficult to control even if patients receive high-dose inhaled corticosteroids and long-acting beta-2 agonists treatment.The birth of bronchial thermoplasty provides a new way to solve this problem.Bronchial thermoplasty is to perform radiofrequency ablation one by one from far to near in the airways with a diameter of more than 3 mm through a bronchoscope,which can effectively reduce the airway smooth muscle mass,improve asthma symptoms,and effectively control asthma.The Global Asthma Initiative guidelines and the European Respiratory Society/American Thoracic Society guidelines all recommend bronchial thermoplasty for the treatment of severe asthma.China officially approved this technology for clinical use in 2014.At present,many hospitals are using this technology,but its complete mechanism of action and long-term clinical efficacy remain the focus of future research.This article reviews the mechanism of action,efficacy,and safety evaluation of bronchial thermoplasty in clinical application.