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慢性阻塞性肺疾病在生命早期的源头
Early-Life Origins of Chronic Obstructive Pulmonary Disease


Fernando D. Martinez ... 呼吸系统疾病 围产医学和儿科 • 2016.09.01

在美国,因慢性阻塞性肺疾病(COPD)死亡的人数仅次于癌症和心血管疾病1。目前COPD没有治愈的疗法,主要是姑息治疗。鉴于大多数晚期COPD病例的气道损伤和(或)实质损伤的程度,所以一旦罹患COPD,实施旨在使病情减缓消退的治疗策略就会面临诸多具有挑战性的障碍。因此,对付COPD的易感因素才是成功可能性最大的方法。截至目前,COPD最常见的致病原因是吸烟(以及贫穷国家的生物质烟气暴露2),因此戒烟可能仍是最成功的预防策略。

直到最近,主流的观点是,在发育过程中(即从出生到大约25岁)所有人——即肯定不会有肺病和注定患COPD的人的肺功能(根据第一秒用力呼气量[FEV1]测定)会达到相同的平台水平。随后FEV1水平下降的速率决定了COPD是否会产生。这个速率是处于生理水平(约每年25 mL)——因而与肺部疾病无关,还是由于吸烟或生物质烟气对小气道和周围薄壁组织的持续和累进的有害效应,速率下降比正常生理水平快得多3,进而导致COPD(图1)?COPD的这种“典型”形式确实是该疾病极为常见的临床表现4;它与慢性支气管炎、肺气肿或慢性支气管炎伴肺气肿有关,其特征是中性粒细胞和CD8介导的炎症。COPD这种形式的复杂生物学机制已得到广泛研究5





作者信息

Fernando D. Martinez, M.D.
From the Asthma and Airway Disease Research Center, University of Arizona, Tucson. Address reprint requests to Dr. Martinez at the Asthma and Airway Disease Research Center, University of Arizona, P.O. Box 210240, Tucson, AZ 85724-5018, or at fdmartin@email.arizona.edu.

 

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