中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2011年
10期
839-844
,共6页
老启芳%钟小宁%何志义%柳广南%吕自力%万鹏
老啟芳%鐘小寧%何誌義%柳廣南%呂自力%萬鵬
로계방%종소저%하지의%류엄남%려자력%만붕
肺疾病,慢性阻塞性%吸烟%肺动脉%炎症
肺疾病,慢性阻塞性%吸煙%肺動脈%炎癥
폐질병,만성조새성%흡연%폐동맥%염증
Pulmonary disease,chronic obstructive%Smoking%Pulmonary artery%Inflammation
目的 研究肺功能正常吸烟者和慢性阻塞性肺疾病(COPD)患者肺腺泡动脉炎症的病理特点。方法 取手术切除的远离周围型肺癌的正常肺组织，分肺功能正常不吸烟组(A组，10例)、肺功能正常吸烟组(B组，13例)、吸烟COPD稳定期组(C组，10例)，比较3组肺腺泡动脉病理结构改变、炎性细胞在非肌型动脉(NMA)、部分肌型动脉(PMA)外膜，肌型动脉(MA)内、中、外膜的浸润水平，并分析其与临床指标的相关性。结果 (1)B组(32.7±7.7)、C组(37.4±4.5)较A组(24.4±5.0)MA比例增高，MA内、中膜增厚，C组MA外膜胶原纤维增生，面积明显增大。(2)B组和C组CD+45白细胞、CD3+总T淋巴细胞、CD8+T淋巴细胞在各型肺腺泡动脉表达的范围和程度均较A组增高，以CD8+T淋巴细胞增高为主，炎性细胞浸润以肺腺泡NMA最为明显，在MA以外膜最显著，且C组较B组明显；而CD4+T淋巴细胞、B淋巴细胞、巨噬细胞、中性粒细胞在3组各型肺腺泡动脉浸润程度比较差异均无统计学意义(P值均＞0.05)。(3)CD45+白细胞、CD3+总T淋巴细胞、CD8+T 淋巴细胞在MA的浸润程度与MA管壁厚度、吸烟指数呈正相关，与第1秒用力呼气容积占预计值百分比呈负相关，CD3+总T淋巴细胞、CD8+T淋巴细胞浸润程度与BODE指数呈正相关，CD8+T淋巴细胞浸润程度与6 min步行距离呈负相关。结论 肺功能正常吸烟者和COPD患者均已出现以CD8+T 淋巴细胞浸润为特征的同性质炎症反应，炎症累及各型肺腺泡动脉，肺动脉炎症是影响COPD临床病程发展的重要因素之一。
目的 研究肺功能正常吸煙者和慢性阻塞性肺疾病(COPD)患者肺腺泡動脈炎癥的病理特點。方法 取手術切除的遠離週圍型肺癌的正常肺組織，分肺功能正常不吸煙組(A組，10例)、肺功能正常吸煙組(B組，13例)、吸煙COPD穩定期組(C組，10例)，比較3組肺腺泡動脈病理結構改變、炎性細胞在非肌型動脈(NMA)、部分肌型動脈(PMA)外膜，肌型動脈(MA)內、中、外膜的浸潤水平，併分析其與臨床指標的相關性。結果 (1)B組(32.7±7.7)、C組(37.4±4.5)較A組(24.4±5.0)MA比例增高，MA內、中膜增厚，C組MA外膜膠原纖維增生，麵積明顯增大。(2)B組和C組CD+45白細胞、CD3+總T淋巴細胞、CD8+T淋巴細胞在各型肺腺泡動脈錶達的範圍和程度均較A組增高，以CD8+T淋巴細胞增高為主，炎性細胞浸潤以肺腺泡NMA最為明顯，在MA以外膜最顯著，且C組較B組明顯；而CD4+T淋巴細胞、B淋巴細胞、巨噬細胞、中性粒細胞在3組各型肺腺泡動脈浸潤程度比較差異均無統計學意義(P值均＞0.05)。(3)CD45+白細胞、CD3+總T淋巴細胞、CD8+T 淋巴細胞在MA的浸潤程度與MA管壁厚度、吸煙指數呈正相關，與第1秒用力呼氣容積佔預計值百分比呈負相關，CD3+總T淋巴細胞、CD8+T淋巴細胞浸潤程度與BODE指數呈正相關，CD8+T淋巴細胞浸潤程度與6 min步行距離呈負相關。結論 肺功能正常吸煙者和COPD患者均已齣現以CD8+T 淋巴細胞浸潤為特徵的同性質炎癥反應，炎癥纍及各型肺腺泡動脈，肺動脈炎癥是影響COPD臨床病程髮展的重要因素之一。
목적 연구폐공능정상흡연자화만성조새성폐질병(COPD)환자폐선포동맥염증적병리특점。방법 취수술절제적원리주위형폐암적정상폐조직，분폐공능정상불흡연조(A조，10례)、폐공능정상흡연조(B조，13례)、흡연COPD은정기조(C조，10례)，비교3조폐선포동맥병리결구개변、염성세포재비기형동맥(NMA)、부분기형동맥(PMA)외막，기형동맥(MA)내、중、외막적침윤수평，병분석기여림상지표적상관성。결과 (1)B조(32.7±7.7)、C조(37.4±4.5)교A조(24.4±5.0)MA비례증고，MA내、중막증후，C조MA외막효원섬유증생，면적명현증대。(2)B조화C조CD+45백세포、CD3+총T림파세포、CD8+T림파세포재각형폐선포동맥표체적범위화정도균교A조증고，이CD8+T림파세포증고위주，염성세포침윤이폐선포NMA최위명현，재MA이외막최현저，차C조교B조명현；이CD4+T림파세포、B림파세포、거서세포、중성립세포재3조각형폐선포동맥침윤정도비교차이균무통계학의의(P치균＞0.05)。(3)CD45+백세포、CD3+총T림파세포、CD8+T 림파세포재MA적침윤정도여MA관벽후도、흡연지수정정상관，여제1초용력호기용적점예계치백분비정부상관，CD3+총T림파세포、CD8+T림파세포침윤정도여BODE지수정정상관，CD8+T림파세포침윤정도여6 min보행거리정부상관。결론 폐공능정상흡연자화COPD환자균이출현이CD8+T 림파세포침윤위특정적동성질염증반응，염증루급각형폐선포동맥，폐동맥염증시영향COPD림상병정발전적중요인소지일。
Objective To study the pathological characteristics of intra-acinar pulmonary artery inflammation and its correlation with smoking index and disease progression in smokers with normal lung function and smokers with chronic obstructive pulmonary disease (COPD).Methods Patients requiting lung resection for peripheral lung cancer were divided into group A (nonsmokers with normal lung function,n = 10), group B (smokers with normal lung function, n = 13), and group C (smokers with stable COPD,n = 10).The lung tissue far away from rumor were resected to compare the pathological changes of intraacinar pulmonary arteries and infiltration level of inflammatory cell in pulmonary non-muscularized arteries (NMA), pulmonary partially muscularized arteries (PMA) and muscularized arteries (MA) among the three groups.The correlation analysis was made among infiltration level, smoking index, percentage of predicted value of forced expiratory volume in one second (FEV,％ Pred), six-minute-walk distance (6MWD) and BODE index.Results (1) Both group B and group C showed the intima and media thickness of MA was significantly higher, the lumen area of MA was narrower and the proportion of MA was higher, and collagenous fiber of MA adventitial proliferated and area increased in group C(P ＜0.05 or P ＜0.01).(2) In group B and group C, the percentage of the intra-acinar pulmonary arteries that contained leukocytes, T lymphocytes, CD8+ T lymphocytes and the number of these positive cells infiltrating the intraacinar pulmonary arteries were increased, especially an increased number of CD8+ T lymphocytes infiltrating in the arterial adventitia as compared with group A, moreover there were significant difference between group C and group B (P ＜ 0.05 or P ＜ 0.01).In group B and group C, the degree of these positive cellsinfiltrating NMA, PMA and MA presented a decreasing sequence (P ＜ 0.05 or P ＜ 0.01).Among the intima, media and adventitia of MA, the infiltration of these positive cells was the highest in the adventitia.Among group A, group B and group C, infiltration degree of CD4+ T lymphocyte, B lymphocyte, macrophage and neutrophil demonstrated no significant difference, also among NMA, PMA and MA (P ＞ 0.05).(3)The number of leukocytes, T lymphocytes, CD8+T lymphocytes infiltrating MA showed a positive correlation with the thickness of MA (r =0.563,0.627,0.589 ,P ＜0.01 ,respectively) and smoking index (r =0.551,0.665, 0.600, P ＜ 0.01, respectively), moreover the degree of these cells infiltrating MA demonstrated negative correlation with FEV1 ％ Pred (r = - 0.763, - 0.703, - 0.767, P ＜ 0.01, respectively).Also infiltrating degree of T lymphocytes and CD8+ T lymphocytes was positively correlated with BODE(r = 0.390,0.476,P ＜ 0.05, respectively). Furthermore the infiltrating degree of CD8+ T lymphocytes had negative correlation with 6MWD (r = - 0.356, P ＜ 0.05).Conclusions (1) Pulmonary arterial inflammation appears in smokers with normal lung function and smokers with COPD patients.It involves in all types of intra-acinar pulmonary arteries especially NMA and infiltrates whole layer of MA with a characteristic of CDs+T lymphocytes infiltrating in the adventitia of intra-acinar pulmonary arteries. (2) Pulmonary inflammation is closely correlated to cigarette smoking and clinical parameters such as BODE index, FEV1％pred and 6MWD.It is one of the key factors affecting the progression of COPD.
