気管支喘息症例における気道過敏性と鼻腔･副鼻腔疾患の関係に関する検討

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  • Relationship between bronchial hyperresponsivenessand nasosinus lesions in patients with bronchial asthma

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Pathological changes of nasosinus occur often in subjects with bronchial asthma. Coexisting nasosinus lesion may affect pathophysiology of lower respiratory tract in asthmatics. The extent of nasal and sinus lesion was quantified in 17 patients with bronchial asthma, and their relationships to atopic status, asthma severity and bronchial hyperresponsiveness were evaluated in this study. Opacification degree of maxillary sinuses and nasal mucosa thickening were quantified using CT scans. The opacification degree was evaluated as (total opacification area)/(total maxillary sinus area). Although the opacification degree of maxillary sinuses in atopic patients showed no significant difference compared with that in non-atopic patients, maximum nasal mucosa thickening in atopic patients had a significant difference compared with that in non-atopic patients (p=0.028). In severe asthmatics, the opacification degree of maxillary sinuses was significantly more prominent compared with those in moderate and mild asthmatics (p=0.0005, p=0.036, respectively). Significantly marked nasal mucosa thickening was recognized in mild asthmatics compared with that in moderate asthmatics (p=0.0462). Regarding bronchial hyperresponsiveness, a significant correlation between Dmin and the opacification degree of maxillary sinuses was observed (rs= -0.551, p=0.0276). Nasal mucosa thickening had no correlation with bronchial hyperresponsiveness. The results suggest that sinusitis may affect bronchial hyperresponsiveness and asthma severity. Treatment of sinusitis may lead to improvement of asthma symptoms.

鼻腔･副鼻腔疾患はしばしば気管支喘息症例に合併が認められ,喘息症例の下気道病態に影響を及ぼしている可能性が考えられる｡今回,気管支喘息17例において,CTを用いて上顎洞の不透明化率･鼻腔粘膜肥厚を計測し,アトピー性の有無,喘息の重症度,気道過敏性との関係を検討した｡上顎洞不透明化率は全上顎洞面積の総計に対する不透明化領域面積総計として計算を行った｡上顎洞不透明化率はアトピー性の有無で差は認められなかったが,鼻腔粘膜はアトピー性喘息症例で有意に肥厚していた｡重症気管支喘息における上顎 洞不透明化率は,中等症および軽症喘息症例に比べ有意に高値であった｡鼻腔粘膜肥厚は中等症喘息症例に比べ,軽症症例で有意に肥厚していた｡気道過敏性(Dmin)は上顎洞不透明化率とのあいだに弱い負の相関が認められた(rs=-0.551,p=0.0276).鼻粘膜肥厚と気道過敏性は相関が認められなかった｡今回の結果から副鼻腔病変が気道過敏性･喘息重症度に影響を及ぼしている可能性が考えられ.副鼻腔疾患の治療により喘息症状の改善に繋がる可能性が考えられた。

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