Relation between Selective Alveolo-bronchography Yoshikazu and Small Airway Function Tests Iwasaki, M. D., Yasuo Tsuya, M. D., Kunio Shiba, M. D., Tomohisa Fujimoto, M. D., Etsuo Fujita, M. D., Renzou Sugihara, M. D., Hiroyoshi Akira Tanaka, Ohmi Takagi, M. D., Ryuhei Hazu, M. D., Akiyama, M. D., Naoko Kishigami, M. D., M. D., Mitsuo Ohishi, M. D. and Shigenori Nakajima, M. D. Fourth Department of Internal Medicine, Kinki University School of Medicine, Osaka To evaluate the validity of scoring method of small airway function tests, selective alveolobronchography (SAB) was performed on 7 patients with bronchial asthma, 7 patients with chronic pulmonary emphysema and a patient with chronic bronchitis. The small airway lesion observed on SAB film was compared with the pulmonary function data including closing volume (CV), dn2/l, volume of isoflow (Visov) and OV50 and further with total score of the abnormalities in CV, ON2, Visov, and OV50 (SAO score). The severity of small airway lesion in SAB was expressed as the mean of maximum diameter/minimum diameter ratioes (ratio of bronchial diameter, RBD) in each 1 cm-long segment on magnified film (3 to 4 fold). 1. Significant but loose correlation was found between FEVI o% and RBD, but correlation was not significant between respiratory resistance and RBD. 2. Among small airway parameters, only CV was significantly correlated with RBD. 3. Significant correlation was found between SAO score and RBD. We conclude that the scoring method of small airway function tests is meaningfull for evaluation of small airway obstruction. Key words: selective alveolo-bronchography, small airway obstruction, ratio of bronchial diameter, small airway obstruction score (SAO score)

日 気 食 会 報, 1. Selective (SAB) Atropine Local 36(6), alveolo-bronchography sulfate 0.5mg anesthesia (im) with 2% Xylocain spray Double lumen, Metras catheter, insertion rt. B8, prewedge Dionosil-Hytrast mixture 50 ml air isjection, 2. Measurement Diameter Ratio of bronchial Dmax / Dmin 100(%) 造 影 剤 を2 3ml注 Small Airway diameter(rbd)= 図2喘 息 例 のSAB 方法 入 後50 ml注 射 器 で 用 手 的 に患 者 の 吸 気 に合 わ せ て50mlの 注 入 した(図1) ほ ぼ 同 等 のSAB像 (1:1) 2-3 ml rapidly of the 図1 FOB 空 気 を急 速 に この 方 法 で も中 村 ら の 方 法 と が 得 られ, 時 間 的 に も短 時 間 で造 影 を終 了 で きた 形 態 的 な末 梢 気 道病 変 の程 度 を定 量 的 に 扱 う た め, 佐 々 木 ら の 方 法 に従 いSABの 影 の フ ィル ム上 で1cm間 拡大 撮 隔 で 気 道 を 区 切 り, この 一 区 間 の 気 道 の 最 大 径 を最 小 径 で割 った 値 の平 均値 をratio of bronchial diameter(rbd) と して 評 価 した(図1) す な わ ち この値 が 大 で あ れ ば あ る ほ ど気 道 壁 の 障 害 は強 い と考 え られ る 図2は, は125.2%で のSAB像 42歳 男性, 喘 息 例 のSAB像 あ っ た 図3は68歳 でRBD 男 性, 肺 気 腫 例 で, 末 梢 気 道 は 分 岐 部 狭 窄, 壁 不 整 を 示 し, 著 明 な末 梢 気 道 病 変 が認 め ら れ, RBD値 も193.7%と RBDはSABの 高 値 を 示 した 両 者 の 比 較 か ら も 気 道 所見 の 定量 的 評価 の 方法 と し て適 当 と考 え られ た11)12)13) 末 梢 気 道 狭 窄 の 機 能 的診 断 と して は, 従 来 よ り報 告8)し て い る とお りcv, =2/L, Visov, V50を そ れ ぞ れ の 異 常 の 程 度 に よ り表3の よ 11-475 図3肺 気腫 例 のSAB 1985

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