重症哮喘的气道病理改变与气流阻塞有关，而与症状控制无关
2018/06/20
摘要
背景：哮喘患者存在结构和炎症改变，这些改变被认为在疾病严重程度中起作用。然而，关于重症哮喘的气道重塑和炎症是否与症状控制和气流阻塞相关尚不十分明晰。我们旨在探索重症哮喘患者支气管活检组织中的几种炎症和结构病理学特征，它们可能与标准治疗后的症状控制和气流阻塞有关。
方法：50例重症哮喘患者接受泼尼松每日40mg治疗2周；配合布地奈德/福莫特罗400/12ug每日两次和按需使用布地奈德/福莫特罗200/6ug，治疗12周。在12周结束时进行支气管内活检。我们对哮喘症状控制和气流阻塞进行分层，利用免疫病理学分析方法，广泛探索了重症哮喘患者的气道组织炎症和重塑特征。
结果：气道组织炎症和气道重塑与症状控制无关。伴有持续性气流阻塞的哮喘患者气道平滑肌（Asm）面积增加，并伴有Asm束内骨膜蛋白和转化生长因子β阳性细胞减少，并且与非持续性气流阻塞患者比较，黏膜下层中糜蛋白酶阳性肥大细胞数量减少。
结论：重症哮喘患者中持续气流阻塞的患者与支气管炎症和气道结构改变有关，而症状控制与气道组织炎症和气道重塑无关。
Airway pathology in severe asthma is related to airflow obstruction but not symptom control
D. S. Ferreira; R. M. Carvalho-Pinto; M. G. Greg_orio; R. Annoni; A. M. Teles; M. Buttignol; B. B. Ara-ujo-Paulino; E. H. Katayama; B. L. Oliveira; H. S. Del Frari; A. Cukier; M. Dolhnikoff; R. Stelmach; K. F. Rabe; T. Mauad.
Allergy. 2018;3: 635-643
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 maintenancetherapy with budesonide/formoterol 400/12 ug twice daily + budesonide/
formoterol 200/6 ug 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.
背景：哮喘患者存在结构和炎症改变，这些改变被认为在疾病严重程度中起作用。然而，关于重症哮喘的气道重塑和炎症是否与症状控制和气流阻塞相关尚不十分明晰。我们旨在探索重症哮喘患者支气管活检组织中的几种炎症和结构病理学特征，它们可能与标准治疗后的症状控制和气流阻塞有关。
方法：50例重症哮喘患者接受泼尼松每日40mg治疗2周；配合布地奈德/福莫特罗400/12ug每日两次和按需使用布地奈德/福莫特罗200/6ug，治疗12周。在12周结束时进行支气管内活检。我们对哮喘症状控制和气流阻塞进行分层，利用免疫病理学分析方法，广泛探索了重症哮喘患者的气道组织炎症和重塑特征。
结果：气道组织炎症和气道重塑与症状控制无关。伴有持续性气流阻塞的哮喘患者气道平滑肌（Asm）面积增加，并伴有Asm束内骨膜蛋白和转化生长因子β阳性细胞减少，并且与非持续性气流阻塞患者比较，黏膜下层中糜蛋白酶阳性肥大细胞数量减少。
结论：重症哮喘患者中持续气流阻塞的患者与支气管炎症和气道结构改变有关，而症状控制与气道组织炎症和气道重塑无关。
（刘蕾 张红萍 王刚 四川大学华西医院中西医结合科呼吸组）
（Allergy. 2018;3: 635-643）
（Allergy. 2018;3: 635-643）
Airway pathology in severe asthma is related to airflow obstruction but not symptom control
D. S. Ferreira; R. M. Carvalho-Pinto; M. G. Greg_orio; R. Annoni; A. M. Teles; M. Buttignol; B. B. Ara-ujo-Paulino; E. H. Katayama; B. L. Oliveira; H. S. Del Frari; A. Cukier; M. Dolhnikoff; R. Stelmach; K. F. Rabe; T. Mauad.
Allergy. 2018;3: 635-643
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 maintenancetherapy with budesonide/formoterol 400/12 ug twice daily + budesonide/
formoterol 200/6 ug 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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上皮IL-6跨信号转导定义了一种新的气道炎症增加的哮喘表型
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在使用吸入性糖皮质激素治疗的哮喘患者中的大型亚组中的难治性2型气道炎症
