Article record

哮喘中鼻旁窦浑浊与下气道黏液栓及管壁增厚：一项双队列计算机断层扫描研究

Paranasal sinus opacification and lower airway mucus plugs and wall thickening in asthma: a two-cohort computed tomography study.

临床研究鼻科IF 3.6Q2

文献信息

PMID	42749225
原文	在 PubMed 查看原文 ↗
发表日期	2026
作者	Yusuke Hayashi 查看其他 12 位作者 Naoya Tanabe；Kaoruko Shimizu；Masanobu Suzuki；Ryo Sakamoto；Hironobu Sunadome；Susumu Sato；Hirokazu Kimura；Hironi Makita；Masaharu Nishimura；Atsuyasu Sato；Satoshi Konno；Toyohiro Hirai
作者单位	Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 查看其他 6 条单位信息 Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan. Electronic address: ntana@kuhp.kyoto-u.ac.jp.；Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan.；Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate school of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.；Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.；Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.；Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan; Hokkaido Medical Research Institute for Respiratory Diseases, Sapporo, Japan.
期刊	Respiratory medicine
SCI 分区	Q2
IF	3.6
研究类型	临床研究 · 临床
所属专科	鼻科

中文摘要

背景： 慢性鼻窦炎与哮喘常共存，但哮喘中鼻旁窦与下气道之间的形态学关系仍不清楚。我们假设鼻旁窦浑浊与哮喘下气道结构异常密切相关。
方法： 我们分析了两个独立的哮喘队列：京都哮喘队列（发现队列）和Hi-CARAT研究（验证队列）。鼻旁窦浑浊定义为鼻旁窦CT上Lund-Mackay评分（LMS）≥ 6。比较LMS ≥ 6与LMS < 6者在中上叶气道和下叶气道的黏液栓评分、右尖段（RB1）和后基底段（RB10）支气管的管壁面积百分比（WA%），以及吸气相CT上的总气道计数。在发现队列中，通过配准的吸气相和呼气相CT测量小气道功能障碍（SAD%）。
结果： 在发现队列和验证队列的96例和180例患者中，分别有21例和75例LMS ≥ 6。LMS ≥ 6的患者在中上叶和下叶气道的黏液栓评分均较高。WA%也增加，尤其是在RB10。在多变量分析中，LMS ≥ 6与更多黏液栓及亚段RB10气道WA%增加独立相关，且不受口服糖皮质激素使用、生物制剂使用、血嗜酸性粒细胞计数和呼出气一氧化氮分数的影响。LMS ≥ 6还与更高的SAD%相关。
结论： CT上的鼻旁窦浑浊与哮喘下气道黏液栓和管壁增厚相关，且独立于2型炎症，支持统一气道概念。

英文摘要

BACKGROUND: Chronic rhinosinusitis and asthma frequently coexist, yet the morphological relationship between paranasal sinus and lower airway in asthma remains unclear. We hypothesized that paranasal sinus opacification is closely associated with lower airway structural abnormalities in asthma.
METHODS: We analyzed two independent asthma cohorts: the Kyoto asthma cohort (discovery) and the Hi-CARAT study (validation). Paranasal sinus opacification was identified as the Lund-Mackay score (LMS) ≥ 6 on paranasal sinus CT. Mucus plugs score in upper-middle lobe airways and lower lobe airways, wall area percentage (WA%) of the right apical (RB1) and posterior basal (RB10) bronchi, and total airway count on inspiratory CT were compared between those with LMS ≥ 6 and LMS < 6. Small airway dysfunction (SAD%) was measured on registered inspiratory and expiratory CT in the discovery cohort.
RESULTS: Of 96 and 180 patients in the discovery and validation cohorts, 21 and 75 had LMS ≥ 6. Patients with an LMS ≥ 6 had higher mucus plugs scores in both upper-middle and lower lobe airways. WA% was also increased, particularly in RB10. In multivariable analyses, LMS ≥ 6 was independently associated with greater mucus plugs and increased WA% in the subsegmental RB10 airways independent of oral corticosteroid use, biologics use, blood eosinophil counts, and fractional exhaled nitric oxide. LMS ≥ 6 was also associated with greater SAD%.
CONCLUSIONS: Paranasal sinus opacification on CT was associated with lower airway mucus plugs and wall thickening in asthma, independent of type 2 inflammation, supporting the unified airway concept.