Remodeling and inflammation of bronchi in asthma and chronic obstructive pulmonary disease.
Remodeling and inflammation of bronchi in asthma and chronic obstructive pulmonary disease.
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DOI：
10.1513/pats.200402-009ms
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发表时间：
2004-01-01
期刊：
影响因子：
--
通讯作者：
Jeffery, Peter K
中科院分区：
文献类型：
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作者：
Jeffery, Peter K
哮喘和慢性阻塞性肺疾病（COPD）在其主要炎性细胞和结构改变（即，重塑）。然而，有许多功能和病理重叠的病例，支持作者的观点，即使用术语哮喘或COPD过于简单化，无法识别存在的表型范围。一般而言，即使在轻度哮喘中，也存在上皮脆性和网状基底膜增厚;在重度哮喘和COPD中，气道平滑肌质量增加、粘液分泌腺肥大、血管分布增加、成纤维细胞数量增多和胶原沉积增加;在COPD中，存在粘液化生、鳞状化生和实质破坏。由于嗜中性粒细胞增多，当哮喘和COPD恶化导致住院时，炎症模式变得相似。此外，在轻度COPD中，支气管炎的恶化与粘膜嗜酸性粒细胞增多和RANTES的上调相关，这两个特征通常与哮喘相关。在口服类固醇可逆的COPD患者中，网状基底膜中度增厚和嗜酸性粒细胞增多也可观察到重叠。重要的是，最近一项关于“嗜酸性支气管炎”的研究表明网状基底膜增厚，并挑战了我们目前对哮喘和COPD之间组织病理学差异的概念。
Asthma and chronic obstructive pulmonary disease (COPD) are pathologically distinct in terms of their predominant inflammatory cells and structural alterations (i.e., remodeling). However, there are many cases of functional and pathologic overlap, supporting the author's view that use of the terms asthma or COPD is oversimplistic and fails to identify the range of phenotypes that exist. In general, there is epithelial fragility and thickening of the reticular basement membrane, even in mild asthma; increased airway smooth muscle mass, hypertrophy of mucus-secreting glands, increased vascularity, greater numbers of fibroblasts, and increased deposition of collagen in severe asthma and COPD; and mucous metaplasia, squamous metaplasia, and parenchymal destruction in COPD. Because of increased neutrophilia, patterns of inflammation become similar when exacerbations of asthma and COPD result in hospitalization. Moreover, in mild COPD, exacerbations of bronchitis are associated with mucosal eosinophilia and upregulation of RANTES, two features normally associated with asthma. The overlap may also be seen in intermediate thickening of the reticular basement membrane and eosinophilia in patients with COPD who demonstrate reversibility to oral steroid. Importantly, a recent study of "eosinophilic bronchitis" demonstrates a thickened reticular basement membrane and challenges our current concept of the histopathologic distinctions between asthma and COPD.