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严重哮喘的气道病理与气流阻塞有关,但与症状控制无关

2018/01/08

   摘要             
   背景:哮喘患者气道结构和炎症的改变,被认为在疾病的严重程度中起作用。然而,在重症哮喘患者中,气道炎症和气道重塑与症状控制和气流阻塞的关系并没有被广泛研究。我们的目的是探究经过规范化治疗的重症哮喘患者的支气管活检气道炎症和结构病理特征是否与症状控制与气流阻塞相关。
   方法:50位重度哮喘患者给予强的松40mg/天2周与布地奈德/福莫特罗400 / 12μg每日2次+布地奈德/福莫特罗200 / 6μg需要维持治疗12周。在12周结束时进行支气管内膜活检。我们对患者进行哮喘症状控制和气流阻塞分层,并对这些患者进行了广泛的气道组织炎症免疫病理分析和重构特征分析。
   结果: 气道组织炎症和重塑与症状控制无关。持续性哮喘患者的气流阻塞大气道平滑肌(ASM)减少骨膜和转化生长因子β阳性细胞在ASM束区,除了较低的糜酶阳性的肥大细胞在黏膜下层的患者相比,非持久性梗阻。气流持续受阻的哮喘患者有更大的气道平滑肌面积,且平滑肌束中缺少骨膜及转化生子因子β细胞,另外,与非持续性气流受阻哮喘患者相比,该类患者气道黏膜下层具有糜蛋白酶活性的肥大细胞数量较少。
   结论:在重症哮喘患者中,哮喘症状与气道炎症及气道重塑无关,尽管这些患者的持续气流受阻与气道炎症及气道结构相关。
 
 
(中日友好医院医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校)
(Allergy. 2017 Sep 27. doi: 10.1111/all.13323)

 
 
 
Airway pathology in severe asthma is related to airflow obstruction but not symptom control.
 
Ferreira DS, Carvalho-Pinto RM
 
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: Fifty severe asthmatics received prednisone 40 mg/d 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 nonpersistent 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.
 


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