天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (1): 83-86.doi: 10.11958/20161522

• 临床研究 • 上一篇    下一篇

慢性阻塞性肺疾病患者脏层胸膜的病理改变

叶蓁1,李月川2,王菁1,徐美林3,张永祥1   

  1. 1 天津医科大学研究生院 （邮编 300070）； 2 天津市胸科医院呼吸与危重症医学科， 3 病理科


  • 收稿日期:2016-12-13 修回日期:2017-01-06 出版日期:2017-01-15 发布日期:2017-01-15
  • 通讯作者: 叶蓁 E-mail:158716995@qq.com

The pathological changes of visceral pleura in Chronic Obstructive Pulmonary Disease patients

LI YUECHUANJing WANGXUMEILIN 2,ZHANG YongXiang   

  1. 1 Graduate School of Tianjin Medical University, Tianjin 300070, China; 2 Department of Respiratory and
    Critical Care Medicine, 3 Department of Pathology, Tianjin Chest Hospital

  • Received:2016-12-13 Revised:2017-01-06 Published:2017-01-15 Online:2017-01-15

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摘要： 摘要： 目的 观察慢性阻塞性肺疾病（COPD）患者脏层胸膜的病理改变， 以及该改变与 COPD 气流受限的关 系。方法 选取 2014 年 5 月—2015 年 8 月于天津市胸科医院胸外科因肺部肿物， 行全肺叶或部分肺叶切除手术患 者 70 例。根据患者肺功能检查结果分为 COPD 组［第 1 秒用力呼气容积（FEV1） /用力肺活量（FVC）＜70%， 40 例］ 与对照组 （FEV1/FVC≥70%， 30 例）。对手术所获取肺组织进行取材 （取材部位未被病变浸润， 距离病变区域>2 cm）、 制作组织切片， 使用弹力纤维染色法 （EVG） 进行染色； 显微镜下观察并计算 2 组脏层胸膜的厚度及弹力纤维所占比 例。结果 COPD 组标本取自肺上、 中叶 22 例， 肺下叶 18 例； 对照组取自肺上、 中叶 17 例， 肺下叶 13 例； 2 组间标 本获取部位差异无统计学意义 （χ2=0.019， P > 0.05）。COPD 组脏层胸膜厚度及脏层胸膜中弹力纤维所占比例均小于 对照组 （均 P < 0.01）。2 组内肺上、 中叶脏层胸膜厚度均明显小于肺下叶 （P < 0.05）， 但肺上、 中叶与肺下叶胸膜中弹 力纤维所占比例差异无统计学意义。结论 脏层胸膜变薄， 弹力纤维减少是 COPD 患者呼气气流受限的原因之一。

关键词: 慢性阻塞性肺疾病, 脏层胸膜, 弹力纤维, 肺弹性回缩力, 呼气气流受限

Abstract: Abstract：Objective To observe the pathological change of visceral pleura in patients with chronic obstructive pulmonary disease (COPD), and to discuss the relationship between the changes and COPD airflow limitation. Methods A total of 70 patients received the pulmonary lobectomy or partial resection because of lung tumor in Tianjin Chest Hospital from May 2014 to August 2015 were selected in this study. According to the results of pulmonary function test, the patients were divided into COPD group [forced expiratory volume in one second (FEV1)/ forced vital capacity (FVC) <70%， n=40] and control group (FEV1/FVC≥70%， n=30). The lung tissues, which was not the lesion areas, were used to make tissue sections. The Elastica Van Gieson (EVG) method was used to stain the sections. The thickness of visceral pleural and the proportion of elastic fibers in visceral pleural were observed and calculated under a microscope in the two groups. Results The specimens were derived from upper and middle lobes in 22 cases of COPD group, and from lower lobe in 18 cases. Specimens were derived from upper and middle lobes in 17 cases of control group, and from lower lobe in 13 cases. There were no statistical differences in sampling sites between two groups (χ2=0.019， P＞0.05). The visceral pleural thickness and the proportion of elastic fibers in visceral pleural were significantly thinner in COPD group than those of control group (P < 0.01). In both COPD group and control group, visceral pleural thickness was significantly thinner in upper and middle lobes than that of lower lobe (P < 0.05), but the proportion of elastic fibers in visceral pleural of upper, middle lobes showed no statistical difference compared with that of the lower lobe (P＞0.05). Conclusion The thinner visceral pleural and the reduction of elastic fibers in visceral pleural are one of the causes of expiratory airflow limitation in COPD patients.

Key words: Chronic Obstructive Pulmonary Disease, visceral pleura, elastic fiber, pulmonary elastic retraction force, expiratory airflow limitation