Pathology of chronic obstructive pulmonary disease
Pathology of chronic obstructive pulmonary disease
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DOI：
10.1007/bf02893433
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发表时间：
2006-05
影响因子：
2.8
通讯作者：
M. Szilasi;T. Dolinay;Z. Nemes;J. Strausz
中科院分区：
文献类型：
--
作者：
M. Szilasi;T. Dolinay;Z. Nemes;J. Strausz
慢性阻塞性肺病是世界范围内导致死亡和发病的主要原因之一。尽管对其进行了深入的研究，但其病理和病理生理机制尚不清楚。这种疾病的特征是不可逆转的气流受限和慢性炎症。进行性炎症和纤维化引起的小气道阻塞，以及弹性溶解和细胞凋亡导致的弹性回弹力的丧失都是导致病理改变的原因。然而，大气道的阻塞在多大程度上会导致肺功能的改变还存在争议。在文献中，三种形态实体被描述为一种疾病；慢性支气管炎、阻塞性毛细支气管炎和肺气肿可同时出现在同一患者中。作者回顾了在慢性阻塞性肺疾病中观察到的病理变化，包括急性加重和继发性肺动脉高压，它们是该疾病严重但常见的并发症。此外，我们详细介绍了主要细胞和分子炎症途径激活的最新科学证据。这些机制导致细胞凋亡加速、重塑和促炎细胞因子释放增加。以细胞内病变为靶点可能会导致新一代药物的发现，这些药物可以在确定呼吸道不可逆性之前减少慢性阻塞。
Chronic obstructive pulmonary disease is one of the leading causes of death and morbidity worldwide. Despite intensive investigation, its pathology and pathophysiology are not well understood. The hallmarks of the disease are irreversible airflow limitation and chronic inflammation. Small airway obstruction due to progressive inflammation and fibrosis, and the loss of elastic recoil mediated by elastolysis and apoptosis equally contribute to pathologic changes. However, it is debated to what extent the obstruction of large airways leads to altered lung function. Three morphologic entities are described in the literature under one disease; chronic bronchitis, obstructive bronchiolitis and emphysema may appear in the same patient at the same time. The authors review pathologic changes observed in chronic obstructive pulmonary disease, including acute exacerbations and secondary pulmonary hypertension as severe but common complications of the disease. Furthermore, we detail recent scientific evidences for major cellular and molecular inflammatory pathway activation. These mechanisms result in accelerated apoptosis, remodeling and increased proinflammatory cytokine release. Targeting intracellular pathological changes may lead to the discovery of a new generation of drugs that could reduce chronic obstruction before airway irreversibility is established.