哮喘缓解的病理生理学研究进展
2019/07/11
摘要
哮喘是一种世界范围内高发的慢性呼吸疾病。尽管目前还没有治愈方法，但人们已经认识到，一些哮喘患者可以在后期自发地进入疾病缓解期。哮喘缓解的特征是症状缓解和减少哮喘药物使用。哮喘缓解的受试者可分为两组：临床缓解者和完全缓解者。临床哮喘缓解受试者仍然具有一定程度的肺功能异常或支气管高反应性，而完全哮喘缓解受试者这些特征不再存在。在较长时期内，后一组不太可能复发。该缓解组具重要的科学意义，因为更可能找到引起或与哮喘缓解相关的生物标志物或生物学通路。尽管哮喘缓解的定义在不同研究之间存在差异，但一些因素可重复地被观察到与哮喘缓解相关。炎症标志物在其中水平较低，完全缓解组中水平最低。另外，在两组中都存在一定程度的气道重塑。尽管如此，哮喘缓解的病理疾病状态仍未得到很好的研究。未来的研究应该集中在至少两个方面：进一步明确小气道和气道壁的特征以便确定组织学上的真正缓解，用更完善的生物学通路分析去探索引发这种现象的诱因。最终，这将有助于找到促使哮喘缓解的有潜力的药理学靶标。
A review on the pathophysiology of asthma remission.
Carpaij OA, Burgess JK, Kerstjens HAM, Nawijn MC, van den Berge M.
Abstract
Asthma is a chronic respiratory condition, which is highly prevalent worldwide. Although no cure is currently available, it is well recognized that some asthma patients can spontaneously enter remission of the disease later in life. Asthma remission is characterized by absence of symptoms and lack of asthma-medication use. Subjects in asthma remission can be divided into two groups: those in clinical remission and those in complete remission. In clinical asthma remission, subjects still have a degree of lung functional impairment or bronchial hyperresponsiveness, while in complete asthma remission, these features are no longer present. Over longer periods, the latter group is less likely to relapse. This remission group is of great scientific interest due to the higher potential to find biomarkers or biological pathways that elicit or are associated with asthma remission. Despite the fact that the definition of asthma remission varies between studies, some factors are reproducibly observed to be associated with remitted asthma. Among these are lower levels of inflammatory markers, which are lowest in complete remission. Additionally, in both groups some degree of airway remodeling is present. Still, the pathological disease state of asthma remission has been poorly investigated. Future research should focus on at least two aspects: further characterisation of the small airways and airway walls in order to determine histologically true remission, and more thorough biological pathway analyses to explore triggers that elicit this phenomenon. Ultimately, this will result in pharmacological targets that provide the potential to steer the course of asthma towards remission.
哮喘是一种世界范围内高发的慢性呼吸疾病。尽管目前还没有治愈方法，但人们已经认识到，一些哮喘患者可以在后期自发地进入疾病缓解期。哮喘缓解的特征是症状缓解和减少哮喘药物使用。哮喘缓解的受试者可分为两组：临床缓解者和完全缓解者。临床哮喘缓解受试者仍然具有一定程度的肺功能异常或支气管高反应性，而完全哮喘缓解受试者这些特征不再存在。在较长时期内，后一组不太可能复发。该缓解组具重要的科学意义，因为更可能找到引起或与哮喘缓解相关的生物标志物或生物学通路。尽管哮喘缓解的定义在不同研究之间存在差异，但一些因素可重复地被观察到与哮喘缓解相关。炎症标志物在其中水平较低，完全缓解组中水平最低。另外，在两组中都存在一定程度的气道重塑。尽管如此，哮喘缓解的病理疾病状态仍未得到很好的研究。未来的研究应该集中在至少两个方面：进一步明确小气道和气道壁的特征以便确定组织学上的真正缓解，用更完善的生物学通路分析去探索引发这种现象的诱因。最终，这将有助于找到促使哮喘缓解的有潜力的药理学靶标。
(中日友好医院呼吸与危重症医学科 顾宪民 摘译 林江涛 审校)
(Pharmacol Ther. 2019 May 8. pii: S0163-7258(19)30076-2. doi: 10.1016/j.pharmthera.2019.05.002.)
(Pharmacol Ther. 2019 May 8. pii: S0163-7258(19)30076-2. doi: 10.1016/j.pharmthera.2019.05.002.)
A review on the pathophysiology of asthma remission.
Carpaij OA, Burgess JK, Kerstjens HAM, Nawijn MC, van den Berge M.
Abstract
Asthma is a chronic respiratory condition, which is highly prevalent worldwide. Although no cure is currently available, it is well recognized that some asthma patients can spontaneously enter remission of the disease later in life. Asthma remission is characterized by absence of symptoms and lack of asthma-medication use. Subjects in asthma remission can be divided into two groups: those in clinical remission and those in complete remission. In clinical asthma remission, subjects still have a degree of lung functional impairment or bronchial hyperresponsiveness, while in complete asthma remission, these features are no longer present. Over longer periods, the latter group is less likely to relapse. This remission group is of great scientific interest due to the higher potential to find biomarkers or biological pathways that elicit or are associated with asthma remission. Despite the fact that the definition of asthma remission varies between studies, some factors are reproducibly observed to be associated with remitted asthma. Among these are lower levels of inflammatory markers, which are lowest in complete remission. Additionally, in both groups some degree of airway remodeling is present. Still, the pathological disease state of asthma remission has been poorly investigated. Future research should focus on at least two aspects: further characterisation of the small airways and airway walls in order to determine histologically true remission, and more thorough biological pathway analyses to explore triggers that elicit this phenomenon. Ultimately, this will result in pharmacological targets that provide the potential to steer the course of asthma towards remission.
