重症哮喘气道病理学与气道阻塞有关，与症状控制无关
2017/10/23
摘要
背景：哮喘患者存在结构和炎症改变，被认为在疾病严重程度上起作用。然而，气道重塑和炎症与重症哮喘患者的症状控制和气流阻塞之间的关系尚未广泛研究。我们旨在调查重症哮喘患者的支气管活检中的几种炎症和结构病理特征，这可能与标准化治疗后的症状控制和气流阻塞有关。
材料与方法：50例重症哮喘患者接受泼尼松40 mg / d治疗2周，布地奈德/福莫特罗400/12μg日两次+布地奈德/福莫特罗200/6μg需要维持治疗12周。12周后行支气管活检。我们分别对哮喘症状控制和气流阻塞患者的气道组织炎症和重塑特征进行了广泛的免疫病理学分析。
结果:气道组织炎症和重塑与症状控制无关。具有持续性气流阻塞的哮喘患者除气道平滑肌束内的骨膜素减少和转化生长因子β阳性细胞之外具有更大的气道平滑肌面积，此外与非持续性阻塞患者相比，粘膜下层中的胃肠增生阳性肥大细胞数量较少。
结论：重症哮喘患者的症状控制与气道组织炎症和重塑无关，尽管这些患者持续气流阻塞与支气管炎和气道结构变化有关。
Airway pathology in severe asthma is related to airflow obstruction but not symptom control.
Ferreira DS1, Carvalho-Pinto RM2, Gregório MG2, Annoni R1, Teles AM1, Buttignol M1, Araújo-Paulino BB1, Katayama EH3, Oliveira BL3, Del Frari HS3, Cukier A2, Dolhnikoff M1, Stelmach R2, Rabe KF4, Mauad T1.
Abstract
BACKGROUND:Patients with asthma present structural and inflammatory alterations that are believed to play a role in disease severity. However, airway remodeling and inflammation have not been extensively investigated in relation to both symptom control and airflow obstruction in severe asthmatics. We aimed to investigate several inflammatory and structural pathological features in bronchial biopsies of severe asthmatics that could be related to symptom control and airflow obstruction after standardized treatment.
METHODS:50 severe asthmatics received prednisone 40 mg/day for 2 weeks and maintenance therapy with budesonide/formoterol 400/12 μg twice daily + budesonide/formoterol 200/6 μg as needed for 12 weeks. Endobronchial biopsies were performed at the end of 12 weeks. We performed extensive immunopathological analyses of airway tissue inflammation and remodeling features in patients stratified by asthma symptom control and by airflow obstruction.
RESULTS:Airway tissue inflammation and remodeling were not associated with symptom control. Asthmatics with persistent airflow obstruction had greater airway smooth muscle (Asm) area with decreased periostin and transforming growth factor beta positive cells within Asm bundles, in addition to lower numbers of chymase positive mast cells in the submucosa compared to patients with non-persistent obstruction.
CONCLUSIONS:Symptom control in severe asthmatics was not associated with airway tissue inflammation and remodeling, although persistent airflow obstruction in these patients was associated with bronchial inflammation and airway structural changes. This article is protected by copyright. All rights reserved.
背景：哮喘患者存在结构和炎症改变，被认为在疾病严重程度上起作用。然而，气道重塑和炎症与重症哮喘患者的症状控制和气流阻塞之间的关系尚未广泛研究。我们旨在调查重症哮喘患者的支气管活检中的几种炎症和结构病理特征，这可能与标准化治疗后的症状控制和气流阻塞有关。
材料与方法：50例重症哮喘患者接受泼尼松40 mg / d治疗2周，布地奈德/福莫特罗400/12μg日两次+布地奈德/福莫特罗200/6μg需要维持治疗12周。12周后行支气管活检。我们分别对哮喘症状控制和气流阻塞患者的气道组织炎症和重塑特征进行了广泛的免疫病理学分析。
结果:气道组织炎症和重塑与症状控制无关。具有持续性气流阻塞的哮喘患者除气道平滑肌束内的骨膜素减少和转化生长因子β阳性细胞之外具有更大的气道平滑肌面积，此外与非持续性阻塞患者相比，粘膜下层中的胃肠增生阳性肥大细胞数量较少。
结论：重症哮喘患者的症状控制与气道组织炎症和重塑无关，尽管这些患者持续气流阻塞与支气管炎和气道结构变化有关。
(中日友好医院呼吸与危重症医学科 王瑞茵 摘译 林江涛 审校)
(Allergy. 2017 Sep 27. doi: 10.1111/all.13323. [Epub ahead of print])
(Allergy. 2017 Sep 27. doi: 10.1111/all.13323. [Epub ahead of print])
Airway pathology in severe asthma is related to airflow obstruction but not symptom control.
Ferreira DS1, Carvalho-Pinto RM2, Gregório MG2, Annoni R1, Teles AM1, Buttignol M1, Araújo-Paulino BB1, Katayama EH3, Oliveira BL3, Del Frari HS3, Cukier A2, Dolhnikoff M1, Stelmach R2, Rabe KF4, Mauad T1.
Abstract
BACKGROUND:Patients with asthma present structural and inflammatory alterations that are believed to play a role in disease severity. However, airway remodeling and inflammation have not been extensively investigated in relation to both symptom control and airflow obstruction in severe asthmatics. We aimed to investigate several inflammatory and structural pathological features in bronchial biopsies of severe asthmatics that could be related to symptom control and airflow obstruction after standardized treatment.
METHODS:50 severe asthmatics received prednisone 40 mg/day for 2 weeks and maintenance therapy with budesonide/formoterol 400/12 μg twice daily + budesonide/formoterol 200/6 μg as needed for 12 weeks. Endobronchial biopsies were performed at the end of 12 weeks. We performed extensive immunopathological analyses of airway tissue inflammation and remodeling features in patients stratified by asthma symptom control and by airflow obstruction.
RESULTS:Airway tissue inflammation and remodeling were not associated with symptom control. Asthmatics with persistent airflow obstruction had greater airway smooth muscle (Asm) area with decreased periostin and transforming growth factor beta positive cells within Asm bundles, in addition to lower numbers of chymase positive mast cells in the submucosa compared to patients with non-persistent obstruction.
CONCLUSIONS:Symptom control in severe asthmatics was not associated with airway tissue inflammation and remodeling, although persistent airflow obstruction in these patients was associated with bronchial inflammation and airway structural changes. This article is protected by copyright. All rights reserved.
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哮喘患者迟发过敏反应的小气道受累
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年龄依赖变应性哮喘的发展与胱硫醚γ-裂解酶缺陷
