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目的探讨不同哮喘状态下网状基底膜厚度与气道壁结构变化的相关性。方法哮喘致死病例5例,哮喘患者死于非相关疾病5例,非哮喘死亡病例5例,取其肺组织,测量相当于纤维支气管镜活检能获取的软骨性气道(大气道)网状基底膜厚度,同时测量大、小气道(膜性气道)横断面的管壁结构,包括平滑肌面积、黏膜下腺体面积,气道内、外壁面积及气管内腔面积的变化,检验其相关性。结果大气道的网状基底膜厚度与平滑肌层面积(12.3μm±2.8μm、12.3μm±1.8μm vs3.5μm±1.2μm;12.7μm±1.9μm、12.3μm±2.9μm vs 4.2μm±0.4μm;r=0.721,P<0.05)、黏膜下腺体面积(r=0.644,P<0.05)、气道内壁面积(0.11 mm±0.03 mm、0.10 mm±0.02 mm vs 0.05mm±0.02 mm;0.27 mm±0.07 mm、0.14 mm±0.07 mm vs 0.08 mm±0.03 mmr=0.799,P<0.01)相关;与小气道的平滑肌面积(r=0.729,P<0.05)、气道内壁面积(r=0.865,P<0.01)相关;而与气管大小(周长)、内腔面积及气道外壁面积不相关。结论大气道的基底膜厚度变化可反映大气道重塑、小气道平滑肌层和气管内壁的改变。监测网状基底膜厚度的变化可用于评估哮喘的气道病理改变,及对哮喘病的长期追踪研究。
Objective To investigate the relationship between the thickness of reticular basement membrane and the changes of airway wall structure in different asthma states. Methods Five patients died of asthma, five died of unrelated asthma, five died of non-asthma. The lung tissue was taken for measurement of the cartilaginous airway (airway) reticular base obtained by fiberoptic bronchoscopy The thickness of the membrane was measured at the same time. The wall structure of large and small airway (membranous airway) was measured, including the area of smooth muscle, the area of submucosal gland, the area of airway and the wall and the area of tracheal lumen. Results The thickness of the reticular basement membrane and the area of the smooth muscle in the airways (12.3μm ± 2.8μm, 12.3μm ± 1.8μm vs 3.5μm ± 1.2μm; 12.7μm ± 1.9μm, 12.3μm ± 2.9μm vs 4.2μm ± 0.4μm; (r = 0.721, P <0.05). The submucosal gland area (r = 0.644, P <0.05) and the area of airway wall (0.11 mm ± 0.03 mm, 0.10 mm ± 0.02 mm vs 0.05 mm ± 0.02 mm; 0.07 mm, 0.14 mm ± 0.07 mm vs 0.08 mm ± 0.03 mmr = 0.799, P <0.01). Compared with small airway smooth muscle area (r = 0.729, 0.01); but not with tracheal size (perimeter), lumen area and airway wall area. Conclusion The change of basement membrane thickness of the airway may reflect the changes of airway remodeling, small airway smooth muscle layer and tracheal lining. Monitoring changes in the thickness of the reticular basement membrane can be used to assess airway pathology in asthma, and long-term follow-up studies of asthma.