学龄前喘鸣儿童中即可见气道重塑与嗜酸性粒细胞浸润
2008/04/30
哮喘的病理特征最早可在什么阶段出现尚不清楚。Saglani等通过气管镜活检标本对学龄前喘鸣儿童（3～5岁）的气道网状基底膜厚度与炎症细胞浸润情况进行了观察。该研究入选者中16例确证有喘鸣（CWs，平均年龄29个月），14例自诉有喘鸣（RWs，平均年龄17个月），10例正常对照（平均年龄19个月）。对入选者行气管镜检查并获取活检标本，测量基底膜厚度及上皮下炎症细胞的密度。
结果：CWs组基底膜厚度明显高于对照组(P < 0.05)，而且CWs组气道嗜酸性粒细胞浸润也远较对照组明显(P < 0.05)，而其余炎症细胞各组间无明显差别。
结果：CWs组基底膜厚度明显高于对照组(P < 0.05)，而且CWs组气道嗜酸性粒细胞浸润也远较对照组明显(P < 0.05)，而其余炎症细胞各组间无明显差别。
因此，作者认为成年期和学龄期的哮喘患者典型的肺部病理改变其实在确证有喘鸣的1～3岁儿童期即已存在，该阶段的干预可延缓哮喘自然病程的进展。
（王苹莉 浙江医科大学附属第二医院呼吸科 310009 摘译）
（Am J Respir Crit Care Med. 2007;176:858-864）
Saglani S, Payne DN, Zhu J, Wang Z, Nicholson AG, Bush A, Jeffery PK.Early detection of airway wall remodeling and eosinophilic inflammation in preschool wheezers. Am J Respir Crit Care Med. 2007 Nov 1;176(9):858-64.
RATIONALE: It is unclear when the pathologic features of asthma first appear. We hypothesized that eosinophilic airway inflammation and epithelial reticular basement membrane (RBM) thickening, absent in wheezy infants, would be present in preschool children with severe, recurrent wheeze. OBJECTIVES: To compare RBM thickness and inflammation in endobronchial biopsies (EBs) from wheezy preschool children and age-matched control subjects.
RATIONALE: It is unclear when the pathologic features of asthma first appear. We hypothesized that eosinophilic airway inflammation and epithelial reticular basement membrane (RBM) thickening, absent in wheezy infants, would be present in preschool children with severe, recurrent wheeze. OBJECTIVES: To compare RBM thickness and inflammation in endobronchial biopsies (EBs) from wheezy preschool children and age-matched control subjects.
METHODS: EBs were obtained from wheezy preschool children (aged 3 mo to 5 yr), undergoing a clinically indicated fiberoptic bronchoscopy. Subjects undergoing fiberoptic bronchoscopy to investigate stridor acted as nonasthmatic controls. RBM thickness was measured and the density of subepithelial, immunologically distinct inflammatory cells was determined and expressed as a volume fraction (%). EBs from 16 children (median age, 29 [7-57] mo) with wheeze confirmed by video questionnaire (confirmed wheezers [CWs]), 14 with reported wheeze (reported wheezers [RWs]) (median age, 17 [8-58] mo), and 10 control subjects (median age, 19 [5-42] mo) were assessed.
MEASUREMENTS AND MAIN RESULTS: RBM thickness in the three groups was as follows: CWs: median, 4.6 (range, 2.9-8.0) microm; RWs: median, 3.5 (2.1-5.4) microm; control subjects: median, 3.8 (2.5-4.7) microm. RBM was significantly thicker in CWs than in control subjects (P < 0.05). Eosinophil density was as follows: CWs: median, 1.07% (range, 0.0-3.52%); RWs: median, 0.72% (0.0-2.04%); control subjects: median, 0.0% (0.0-1.05%). Eosinophilic inflammation was significantly greater in CWs compared with control subjects (P < 0.05). There were no between-group differences for any other inflammatory cell phenotype.
CONCLUSIONS: The characteristic pathologic features of asthma in adults and school-aged children develop in preschool children with confirmed wheeze between the ages of 1 and 3 years, a time when intervention may modify the natural history of asthma.
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中度及重度哮喘气道细胞因子差异性比较
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