気管支喘息患者における気道の構造変化に関する研究

抄録

The existence of bronchial spasm, though clinically accepted, is less easily demonstrable by the evidence obtained from postmortem examination. Anderson described in his textbook that inflammatory thickening of the mucosa and obstruction of the lumina by thick tenacious mucus are more important in fatal cases than bronchiolar spasm from the postmortem examination of the lung of asthmatic dying during an acute attack. But very little is described about bronchial spasm. It seems difficult to prove the presence of spasm by pathological findings, because the tonus of bronchial muscle may decrease at the postmortem lung. Therefore four times magnifying alveolobronchography was performed on one hundred cases of asthmatic patients.
Material and Results:
Seventeen cases of chronic pulmonary emphysema as the complication of asthma were included in one hundred cases of asthmatic patients. Except these cases, fifty-one cases that showed less than 200γ in histamine inhalation threshold tests were selected as the pure asthma and they were compared with twenty-seven patients of chronic bronchitis who satisfied the Fletcher's criteria for the diagnosis of the chronic bronchitis.
1) In the comparison with bronchographic findings of bronchial asthma and chronic bronchitis, more irregularities of bronchial wall were noted in the chronic bronchitis than in the asthma. On the other hand, spastic narrowing and strangulation were noted in the asthma more than in the chronic bronchitis.
2) Seventeen cases out of fifty-one patients with asthma satisfied the Fletcher's criteria. In these cases the findings such as ‘beading’, strangulation, opening of dividing angle of branches and hyperswelling of peripheral airway were recognized more than in the cases that did not satisfy the Fletcher's criteria.
3) In the patients with asthma, the spastic narrowing appeared in the subsegmental bronchi with the highest percentage and strangulation occured most in the small bronchi.
4) Asthmatic patients complicated with chronic pulmonary emphysema or suffering from serious attack, have more bronchographic changes, especially irregularity of bronchial wall, dilatation of caliber and strangulation than mild cases.
5) The alteration of findings between during the attack and the remission with bronchodilator were discussed on about ten cases. In spite of recovery of subjective symptoms, there were no dilation of bronchi in half of the cases. Another five cases showed some remission of bronchial spasm and the dilated parts were noted in only segmental bronchi or subsegmental bronchi.
6) Even in the group of asthma who showed that FEV 1.0/VC arrived already above 71% and were ree from attack for more than three weeks, sixty percent of the patients had some airway narrowing, though they had been clinically recognized to be at the concalescent stage.