慢性閉塞性肺疾患, とくに慢性気管支炎と慢性肺気腫の臨床診断に関する研究

抄録

This study was proceeded to clarify the methods of differentiation among chronic bronchitis, chronic pulmonary emphysema and bronchial asthma, and to clarif disagreement between the bronchographic findings and clinical diagnostic methods performed up to the present day; for example, Fletcher's criteria for chronic bronchitis and FEV₁ % for chronic pulmonary emphysema.
The enlarged selective alveolo-bronchography was performed on 132 patients with chronic obstructive lung disease in order to observe directly the morphological changes on bronchial trees and alveoli.
The diagnostic standards of each disease by bronchographic findings were determined as follows: According to Reid's opinion, the fundamental change in chronic bronchitis is hypertrophy of mucus-secreting structures. Consequently chronic bronchitis was diagnosed by morphological findings on bronchial wall. According to the definition by W. H. O., bronchial asthma referes to the condition of subjects with widespread narrowing of the bronchial airways, which changes its severity over short periods of time either spontaneously or under treatment. Consequently bronchial asthma was diagnosed by observation of the bronchial narrowing or spasm on the bronchogram and the reversibility of pulmonary functions on the spirography. Chronic pulmonary emphysema was diagnosed by observation of the destructive changes in the terminal respiratory units, by means of the selective alveolobronchography.
Each disease was devided into three degrees of the bronchographic severity from 1st grade to 3rd grade.
Results:
1) The bronchographic findings of 63 cases with Fletcher's criteria were compared with those of 69 cases without Fletcher's criteria. The mean degrees of severity of bronchographic findings of chronic bronchitis and chronic pulmonary emphysema were 1.3 and 0.8 degrees respectively in the cases with Fletcher's criteria. On the other hand, those were 0.9 and 0.4 degrees respectively in the cases without Fletcher's criteria.
Above observations show that the patients with Fletcher's criteria have not only chronic bronchitis but also chronic pulmonary emphysema.
2) Bronchographic findings of chronic bronchitis, chronic pulmonary emphysema and bronchial asthma were observed predominantly in 63%, 18% and 9% respectively of 63 cases with Fletcher's criteria.
3) Bronchographic findings of chronic bronchitis and bronchial asthma were observed predominantly in 44% and 45% respectively of 69 cases without Fletcher's criteria, but those of chronic pulmonary emphysema were in only one case of them.
4) The complication of chronic bronchitis and chronic pulmonary emphysema was examined. All of 41 cases with the bronchographic findings of chronic pulmonary emphysema out of 132 cases have findings of chronic bronchitis also. However, the degrees of severity of chronic pulmonary emphysema were not always observed in proportion to those of chronic bronchitis.
5) The cases with predominant bronchographic findings of chronic pulmonary emphysema were 16 (73%) out of 22 cases within 40% of FEV₁ %, 5 (26%) out of 19 cases between 41 and 55% of FEV₁ %, 7 (19%) out of 36 cases between 56 and 70% of FEV₁ %. If the diagnostic standard for chronic pulmonary emphysema by FEV₁ % is defined to be in less than 55% of FEV₁ %, the diagnostic accuracy of the standard showed only 51%. It was mainly due to contained the cases with intractable asthma among the cases between 41 and 55% of FEV₁ % that the diagnostic accuracy showed low value.
The mean degrees of severity of bronchographic findings of chronic pulmonary emphysema increased in inverse proportion to the decrease of FEV₁ %. On the other hand, those of chronic bronchititis and bronchial asthma were not correlative with FEV₁ %.