The role of airway smooth muscle in the pathogenesis of airway wall remodeling in chronic obstructive pulmonary disease.
The role of airway smooth muscle in the pathogenesis of airway wall remodeling in chronic obstructive pulmonary disease.
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DOI：
10.1513/pats.200504-028sr
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发表时间：
2005-01-01
期刊：
影响因子：
--
通讯作者：
Chung, Kian Fan
中科院分区：
文献类型：
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作者：
Chung, Kian Fan
慢性阻塞性肺疾病患者的小气道存在气道壁重塑过程，包括组织修复和上皮化生，导致气道壁增厚和气流阻塞。随着疾病严重程度的增加，也有粘液化生和粘膜下腺肥大，支气管周围纤维化，以及呼吸道平滑肌质量的增加。除收缩特性外，气道平滑肌还能产生炎性细胞因子、蛋白水解酶和生长因子，这些物质可能参与肌肉的重塑过程并引起表型改变。气流受限对β-受体激动剂和皮质类固醇治疗的反应最小，与哮喘不同，这可能是因为β受体或糖皮质激素受体数量的变化，受体信号的变化，或者是支气管周围纤维化造成的收缩限制。吸入长效β-激动剂和皮质类固醇的联合使用效果更好。这可能是由于气道平滑肌水平的影响所致。气道壁重塑可能涉及炎性细胞或驻留细胞释放生长因子。戒烟或目前的治疗对气道壁重塑的影响尚不清楚。气道壁重塑的特殊治疗方法可能是必要的，结合成像小气道壁重塑的非侵入性方法来评估疗效。
Airway wall remodeling processes are present in the small airways of patients with chronic obstructive pulmonary disease, consisting of tissue repair and epithelial metaplasia that contribute to airway wall thickening and airflow obstruction. With increasing disease severity, there is also increased mucous metaplasia and submucosal gland hypertrophy, peribronchial fibrosis, and an increase in airway smooth muscle mass. Apart from its contractile properties, airway smooth muscle produces inflammatory cytokines, proteases, and growth factors, which may contribute to the remodeling process and induce phenotypic changes of the muscle. Airflow limitation responds minimally to beta-agonists and corticosteroid therapy, unlike asthma, perhaps because of alterations in beta-receptor or glucocorticoid receptor numbers, alterations in receptor signaling, or the constrictive limitation imposed by peribronchial fibrosis. Better response is observed with the combination of inhaled long-acting beta-agonists and corticosteroids. This could result from effects at the level of airway smooth muscle. Airway wall remodeling may involve the release of growth factors from inflammatory or resident cells. The influence of smoking cessation or of current therapies on airway wall remodeling is unknown. Specific therapies for airway wall remodeling may be necessary, together with noninvasive methods of imaging small airway wall remodeling to assess responses.