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以胸闷为特点的胸闷变异性哮喘发病机制研究进展

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胸闷变异性哮喘(CTVA)是以胸闷为唯一或主要表现的不典型哮喘。胸闷的潜在感受器是支气管C纤维或快适应受体,神经冲动通过迷走神经上传,神经中枢可能在大脑皮质中的几个不同区域。胸闷与感知能力有关,胸闷者可能对肺功能微小的改变感知能力更强,但这种感知能力与呼吸肌活动、肺过度充气状态以及呼吸系统机械负荷无关。CTVA患者的气道炎症、肺通气功能障碍尤其是小气道功能障碍以及气道高反应性可能是产生胸闷的原因。CTVA患者易合并焦虑症和抑郁症,焦虑症和抑郁症与呼吸困难有相似的中枢神经处理通路,提示CTVA的发病存在神经生理学基础。本文从胸闷症状的识别及产生机制出发,结合CTVA的气道炎症、通气功能障碍、气道高反应性及精神心理因素等特点及其导致胸闷的机制研究进展,探讨CTVA的发病机制。
Research progress on the pathogenesis of chest tightness variant asthma characterized by chest tightness
Chest tightness variant asthma(CTVA)is an atypical form of asthma with chest tightness as the sole or predominant symptom.The underlying receptors for chest tightness are bronchial C-fibers or rapidly adapting receptors.The nerve impulses are transmitted via the vagus nerve and processed in different regions of the cerebral cortex.Chest tightness is associated with sensory perception,and CTVA patients may have heightened ability to detect subtle changes in lung function,but such sensory perception is unrelated to respiratory muscle activity,lung hyperinflation,or mechanical loading of the respiratory system.Airway inflammation,pulmonary ventilation dysfunction(especially involving small airways),and airway hyperresponsiveness may underlie the sensation of chest tightness.CTVA patients are prone to comorbid anxiety and depression,which share similar central nervous system processing pathways with dyspnea,suggesting a possible neurological basis for the development of CTVA.This article examines the recognition and mechanisms of chest tightness,and explores the pathogenesis of CTVA,focusing on its association with airway inflammation,ventilation dysfunction,airway hyperresponsiveness,and psychosocial factors.

Chest tightnessChest tightness variant asthmaPerceptionPsychosisAirway inflammationMechanismReview

车鸾卿、赖建幸、黄华琼、李雯、沈华浩

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浙江大学医学院附属第二医院呼吸与危重症医学科 浙江省呼吸疾病诊治及研究重点实验室,浙江 杭州 310009

胸闷 胸闷变异性哮喘 感知 精神心理 气道炎症 发病机制 综述

国家自然科学基金国家自然科学基金浙江省自然科学基金浙江大学医学院附属第二医院多中心RCT项目

8193000381700040LY22H010004RCT-2023-006A

2024

浙江大学学报(医学版)
浙江大学

浙江大学学报(医学版)

CSTPCD北大核心
影响因子:0.926
ISSN:1008-9292
年,卷(期):2024.53(2)
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