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目的应用哮喘控制测试(ACT)评估气道壁面积和临床哮喘控制的关系。方法系横断面研究,评估96例成人的哮喘控制程度[“控制佳”(ACT≥20;n=52),或“控制不佳”(ACT<20;n=44),以及气道尺寸:管腔面积(LA)、气道壁面积(WA)和WA%],利用容积CT图像的自动专用软件测量。对右上叶段支气管、亚段支气管和基底段支气管,以及所有未校正和校正后的体表面积(BSA)结果进行分析。结果所有BSA校正后的支气管,气道壁面积与ACT评分无相关性。未校正的WA与ACT评分有较弱的统计学相关性(r=-0.203;P=0.047);“控制不佳”亚组的WA值高于“哮喘控制佳”亚组病人。对于亚段支气管,ACT评分和WA/BSA(r=-0.204;P=0.047)及WA(r=-0.249;P=0.014)均相关。对于上叶支气管,ACT评分和WA(r=-0.207;P=0.044)相关。结论我们证明亚段支气管的气道测量与哮喘的临床控制存在相关性,这可能反映了控制较差的慢性哮喘病人的气道重塑和结构改变。要点①容积CT为支气管形态学提供了新的视野。②评估了当前哮喘控制与气道壁异常间的关系。③证明了气道壁面积与临床控制间的一些关系。④我们观察到“控制不佳”哮喘病人的气道形态变化较小。
Objective To evaluate the relationship between airway wall area and clinical asthma control using the Asthma Control Test (ACT). METHODS: A cross-sectional study was conducted to assess the degree of control of asthma in 96 adults (ACT ≥20; n = 52), or “poorly controlled” (ACT <20; n = 44) Airway size: luminal area (LA), airway wall area (WA), and WA%] were measured using automated software specific to volume CT images. Bronchus in the right upper lobe, subbronchial and basal ganglia, and all uncorrected and corrected body surface area (BSA) results were analyzed. Results All BSA-corrected bronchial and airway wall areas had no correlation with ACT scores. The uncorrected WA had a weaker statistical correlation with the ACT score (r = -0.203; P = 0.047); WA in the less well-controlled subgroup was higher than in the subgroup “asthma control subgroup” . The ACT score was correlated with WA / BSA (r = -0.204; P = 0.047) and WA (r = -0.249; P = 0.014) for sub-bronchus. For the upper lobes, the ACT score was associated with WA (r = -0.207; P = 0.044). CONCLUSIONS We demonstrate that sub-bronchial airway measurements correlate with the clinical management of asthma, which may reflect airway remodeling and structural changes in poorly controlled chronic asthmatics. Points ① Volumetric CT provides a new perspective on bronchial morphology. ② evaluated the current relationship between asthma control and airway wall abnormalities. ③ proved that the relationship between airway wall area and clinical control. ④ We observed that “poorly controlled” asthma patients had less change in airway morphology.