【摘要】：【目的】應(yīng)用氣道內(nèi)超聲(EBUS)檢測(cè)慢性阻塞性肺疾病(COPD)患者的氣道重塑,并探討EBUS測(cè)量的COPD患者氣道徑線與患者肺功能之間的關(guān)系�！痉椒ā�40例受試者分為COPD組(20例)和對(duì)照組(20例)兩組,均進(jìn)行EBUS及肺功能檢查。EBUS檢查受試者的左主支氣管、左上葉支氣管、右中葉支氣管和右下葉后基底段支氣管(B10),并測(cè)量其管壁總厚度(T)、黏膜層厚度(TL1)、黏膜下層厚度(TL2)、外膜層總厚度(TL3~L5)、管腔面積(Ai)和管壁面積(WA)�！窘Y(jié)果】左主支氣管:COPD組的T、TL1、TL2、WA大于對(duì)照組,P均0.05,兩組TL3~L5、Ai相近;左上葉支氣管:COPD組的T、TL1、WA大于對(duì)照組,P均0.05,兩組TL2、TL3~L5、Ai相近;右中葉支氣管和右B10:COPD組的T、TL1、TL2、WA大于對(duì)照組,Ai小于對(duì)照組,P均0.05,兩組TL3~L5相近。相關(guān)性分析:左主支氣管的徑線與肺功能無(wú)顯著相關(guān)關(guān)系。葉支氣管的黏膜層和黏膜下層的增厚與COPD的氣流受限相關(guān),結(jié)果如下:COPD患者左上葉支氣管TL1與FEV1、FVC(r=-0.517~-0.448)呈負(fù)相關(guān)。右中葉支氣管的TL1與FEV1/FVC呈負(fù)相關(guān)(r=-0.533);TL2與FEV1、FVC(r=-0.590~-0.507)呈負(fù)相關(guān)。相對(duì)于葉支氣管,右B10黏膜層和黏膜下層厚度與氣流受限的相關(guān)性更強(qiáng),管壁總厚度和面積與氣流受限的相關(guān)性不及黏膜(L1)和黏膜下層(L2)強(qiáng),結(jié)果如下:右B10的T與FEV1、FEV1%、FVC和FVC%(r=-0.519~-0.504)呈負(fù)相關(guān);TL1與FEV1、FEV1%、FVC、FVC%和FEV1/FVC(r=-0.902~-0.566)呈負(fù)相關(guān);TL2與FEV1、FEV1%和FVC%呈負(fù)相關(guān)(r=-0.597~-0.472);Ai與FEV1(r=0.475)、FEV1%、FVC和FVC%呈正相關(guān)(r=0.457~0.527);WA與FEV1%和FVC%(r=-0.502~-0.470)呈負(fù)相關(guān)�！窘Y(jié)論】COPD患者1~4級(jí)支氣管的氣道壁明顯增厚,尤其是黏膜層和黏膜下層,管腔有狹窄趨勢(shì),這些氣道的徑線與氣流受限存在一定的相關(guān)性,并且這種相關(guān)關(guān)系在分級(jí)較高的支氣管中較明顯;EBUS相對(duì)無(wú)創(chuàng),并且可以精確的反映氣道壁各層厚度的實(shí)際變化,是理想的氣道形態(tài)學(xué)檢測(cè)方法,并有希望成為COPD氣道重塑的診斷手段。
[Abstract]:[objective] to detect airway remodeling in patients with chronic obstructive pulmonary disease (COPD) by intraairway ultrasound (EBUS). [methods] 40 subjects were divided into two groups: COPD group (n = 20) and control group (n = 20). Both EBUS and pulmonary function were examined. EBUS was used to examine the left main bronchus. The left upper lobe bronchus, The thickness of (T), mucosal layer (TL1), submucosal thickness (TL2), total adventitia thickness (TL3~L5), lumen area (Ai) and left main bronchus (WA).) were measured in the right middle lobe bronchus and the right inferior posterior basal segment bronchus (B10). [results] left main bronchus: COPD group The TL3~L5,Ai of TL1 / TL2OWA was higher than that of the control group (P < 0.05). The TL3~L5,Ai of the two groups was similar. Left superior lobar bronchus: TL1WA in COPD group was higher than that in control group (P 0.05), TL2,TL3~L5,Ai was similar in two groups, TL1TL1 TL2WA in right middle lobe bronchus and right B10:COPD group was higher than that in control group, Ai was lower than that in control group (P 0.05), TL3~L5 in both groups was similar. Correlation analysis: there was no significant correlation between the diameter of left main bronchus and pulmonary function. The thickening of the mucous layer and submucous layer of lobar bronchus was related to the airflow limitation of COPD. The results were as follows: the TL1 of left upper lobe bronchus was negatively correlated with FEV1,FVC (r-0.517 ~ 0.448) in patients with COPD. There was a negative correlation between TL1 and FEV1/FVC in the right middle lobe bronchus (r-0.533), and a negative correlation between TL2 and FEV1,FVC (r-0.590 ~ 0.507). Compared with lobar bronchus, the thickness of right B10 mucosal layer and submucosal layer was more correlated with airflow limitation than that of mucosal (L1) and submucosal submucosa (L2), and the correlation between total thickness and area of wall was less than that of mucosal (L1) and submucosal (L2). 緇撴灉濡備笅:鍙矪10鐨凾涓嶧EV1,FEV1%,FVC鍜孎VC%(r=-0.519~-0.504)鍛堣礋鐩稿叧;TL1涓嶧EV1,FEV1%,FVC,FVC%鍜孎EV1/FVC(r=-0.902~-0.566)鍛堣礋鐩稿叧;TL2涓嶧EV1,FEV1%鍜孎VC%鍛堣礋鐩稿叧(r=-0.597~-0.472);Ai涓嶧EV1(r=0.475),FEV1%,FVC鍜孎VC%鍛堟鐩稿叧(r=0.457~0.527);WA涓嶧EV1%鍜孎VC%(r=-0.502~-0.470)鍛堣礋鐩稿叧.銆愮粨璁恒，

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