Epithelial damage and angiogenesis in the airways of children with asthma
Epithelial damage and angiogenesis in the airways of children with asthma
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DOI：
10.1164/rccm.200602-189oc
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发表时间：
2006-11-01
影响因子：
24.7
通讯作者：
Saetta, Marina
中科院分区：
文献类型：
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作者：
Barbato, Angelo;Turato, Graziella;Saetta, Marina
理由：气道重塑和炎症是成人哮喘的特征，但在儿童哮喘中研究甚少。目的：探讨哮喘患儿气道上皮和血管的变化及炎症反应。方法：我们分析了44名接受支气管镜检查的儿童的支气管活检，以确定哮喘以外的适当临床适应症：17名患有轻度/中度哮喘（2-15岁），12名患有特应性哮喘（1-11岁），以及15名没有特应性或哮喘的对照组儿童（1-14岁）。通过组织化学和免疫组织化学，我们量化了上皮损失、基底膜厚度、血管数量和上皮下的炎症细胞。结果：哮喘患儿上皮细胞损失和基底膜厚度均较对照组（p = 0.005和p = 0.0002）和特应性儿童（p = 0.002和p = 0.005）增加。哮喘患儿血管数量和嗜酸性粒细胞数量均较对照组增加（p = 0.03和p = 0.0002），非哮喘特应性儿童血管数量和嗜酸性粒细胞数量均较对照组增加（p = 0.03和p = 0.008）。当我们根据年龄对分析进行分层时，我们观察到6岁以下的哮喘儿童与相同年龄的对照组相比，上皮丢失、基底膜增厚和嗜酸性粒细胞增多。结论：上皮损伤和基底膜增厚是成人哮喘的病理特征，即使在儿童哮喘中也存在。其他变化，如气道嗜酸性粒细胞增多和血管生成，也观察到特应性儿童没有哮喘。这些观察结果表明，病理改变发生在哮喘的自然史早期，并强调了这样一个概念，即即使在没有哮喘症状的情况下，某些病变也可能是特应性的特征。
Rationale: Airway remodeling and inflammation are characteristic features of adult asthma that are still poorly investigated in childhood asthma.Objectives: To examine epithelial and vascular changes as well as the inflammatory response in airways of children with asthma.Methods: We analyzed bronchial biopsies obtained from 44 children undergoing bronchoscopy for appropriate clinical indications other than asthma: 17 with mild/moderate asthma (aged 2-15 yr), 12 with atopy without asthma (1-11 yr), and 15 control children without atopy or asthma (1-14 yr). By histochemistry and immunohistochemistry, we quantified epithelial loss, basement membrane thickness, number of vessels, and inflammatory cells in subepithelium.Results: Epithelial loss and basement membrane thickness were increased in children with asthma compared with control subjects (p = 0.005 and p = 0.0002, respectively) and atopic children (p = 0.002 and p = 0.005, respectively). The number of vessels and eosinophils was increased not only in asthmatic children (p = 0.03 and p = 0.0002, respectively) but also in atopic children without asthma (p = 0.03 and p = 0.008, respectively) compared with control subjects. When we stratified the analysis according to age, we observed that children with asthma younger than 6 yr had increased epithelial loss, basement membrane thickening, and eosinophilia compared with control subjects of the same age.Conclusions: Epithelial damage and basement membrane thickening, which are pathologic features characteristic of adult asthma, are present even in childhood asthma. Other changes, such as airway eosinophilia and angiogenesis, were also observed in atopic children without asthma. These observations suggest that pathologic changes occur early in the natural history of asthma and emphasize the concept that some of these lesions may characterize atopy even in the absence of asthmatic symptoms.