HRCT를 이용한 천식의 중증도에 따른 기도개형의 평가
High resolution computed tomographic assessment of airway remodeling: comparison according to the severity of asthma
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목적 : 기도 개형은 천식의 특징으로 최근 HRCT가 기도벽의 비후와 같은 기도 개형의 평가에 유용한 것으로 알려지고 있다. 기도벽의 비후는 천식의 중증도와 연관이 있다고 알려지고 있지만 국내 연구는 드문 상태이다. 본 연구는 성인 천식 환자에서 중증도에 따른 기도벽의 비후도 차이를 비교하고 이와 폐기능 및 기관지 과민성과의 상관관계를 살펴보고자 하였다. 방법 : 37명의 성인 천식 환자(경증 천식 17명, 중등증 천식 11명, 중증 천식 9명) 를 대상으로 HRCT를 시행하여 기도벽의 두께(T), 기도 내경(d)를 측정한 후, 기도 외경(D)을 계산하여 구한 T/D 비를 기도벽의 비후도 지표로 이용하여 각 군 사이의 차이를 살펴보고 폐기능 및 기관지 과민성과의 상관관계를 살펴보았다. 결과 : 기도벽의 비후도(T/D 비)는 중등증과 중증 천식군에서 경증 천식군보다 전체 기도에서 크게 나타났다(0.278±0.014, 0.281±0.019 vs. 0.228±0.013; 각각 p=0.022, p=0.021). 소기도에서도 기도벽의 비후도는 중증 천식군에서 경증 천식군보다 컸다(0.313±0.018 vs. 0.253±0.013; p=0.009). 대기도에서는 세군간에 비후도 차이가 없었다. 기도벽의 비후도는 폐기능 상의 FEV1 절대값 및 % 예측치와 전체 기도(r=-0.519, p=0.001; r=-0.396, p= 0.015), 소기도(r=-0.567, p<0.001; r=-0.450, p=0.008) 및 대기도(r=-0.395, p=0.015; r=-0.351, p=0.033)에서 유의한 역상관관계를 보였다. 기도벽의 비후도와 기관지 과민성과는 상관관계를 보이지 않았다. 결론 : 기도벽의 비후는 경증 천식보다 중등증과 중증 천식에서 심해지고 기도벽의 비후도가 클수록 기도 폐쇄가 심해진다.
Abstract
Background : Airway remodeling is characterized by an increase in the airway wall thickness. We aimed to compare the airway wall thickness among asthmatic subjects with different severity and to examine its relation to pulmonary function and airway hyperresponsiveness. Methods : Thirty-seven adult asthmatics were assigned to mild (MA, n=17), moderate (MoA, n=11), and severe (SA, n=9) groups according to the Global Initiative for Asthma classification. Patients with more than 10 pack-years of smoking history were excluded. We measured the airway wall thickness (T) and internal diameter (d) using high-resolution computed tomography, and then calculated the external diameter (D). The T/D ratio was compared between the groups and correlations between the T/D ratio and pulmonary function (methacholine PC20) were assessed. Results : The mean T/D ratio was significantly higher in the MoA and the SA groups than in the MA group for the total airways (0.278±0.014, 0.281±0 .019 vs. 0.228±0.013; p=0.022, p=0.021, respectively). The mean T/D ratio was also higher in the SA group than the MA group for the small airways (0.313±0.018 vs. 0.253±0.013; p=0.009). However, there were no significant differences for the large airways. The mean T/D ratio negatively correlated with FEV1 (L) and FEV1 (% of predicted) in total airways (r=-0.519, p=0.001; r=-0.396, p=0.015), small airways (r=-0.567, p<0.001; r=-0.450, p=0.008) and large airways (r=-0.395, p=0.015; r=-0.351, p=0.033). The methacholine PC20 was not related to the T/D ratio. Conclusions : This study suggests that patients with moderate to severe asthma have greater airway remodeling than those with mild asthma, and the degree of airway wall thickening correlates to the severity of airflow obstruction. (Korean J Med 73:631-637, 2007)
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