Remodeling in asthma
Remodeling in asthma
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DOI：
10.1016/j.jaci.2011.04.047
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发表时间：
2011-09-01
影响因子：
14.2
通讯作者：
Hamid, Qutayba
中科院分区：
文献类型：
--
作者：
Al-Muhsen, Saleh;Johnson, Jill R.;Hamid, Qutayba
气道重塑包括与正常气道相比，哮喘患者气道结构的改变。哮喘患者的气道重塑涉及广泛的病理生理学特征，包括上皮变化、平滑肌质量增加、活化的成纤维细胞/肌成纤维细胞数量增加、上皮下纤维化和血管变化。从气道组织中的炎症细胞和结构细胞释放的多种细胞因子、趋化因子和生长因子产生了驱动这些结构变化的复杂信号环境。然而，最近的研究已经改变了我们对哮喘的理解，从一个纯粹的炎症性疾病的疾病，炎症和结构成分同样参与。一些报告表明，哮喘的发生主要是由于上皮层的严重缺陷，这使得环境过敏原、微生物和毒素更容易进入气道组织，并且还可以刺激上皮释放介质，从而促进组织重塑。肺内的成纤维细胞和平滑肌细胞也参与了气道重塑的发病机制。重塑被认为会导致持续的气流限制、肺功能下降和气道高反应性。与健康受试者相比，哮喘受试者经历肺功能的加速下降，这与其疾病的持续时间和严重程度成比例地相关。（J Allergy Clin Immunol 2011;128：451-62.）
Airway remodeling encompasses the structural alterations in asthmatic compared with normal airways. Airway remodeling in asthmatic patients involves a wide array of pathophysiologic features, including epithelial changes, increased smooth muscle mass, increased numbers of activated fibroblasts/myofibroblasts, subepithelial fibrosis, and vascular changes. Multiple cytokines, chemokines, and growth factors released from both inflammatory and structural cells in the airway tissue create a complex signaling environment that drives these structural changes. However, recent investigations have changed our understanding of asthma from a purely inflammatory disease to a disease in which both inflammatory and structural components are equally involved. Several reports have suggested that asthma primarily develops because of serious defects in the epithelial layer that allow environmental allergens, microorganisms, and toxins greater access to the airway tissue and that can also stimulate the release of mediators from the epithelium, thus contributing to tissue remodeling. Lung-resident fibroblasts and smooth muscle cells have also been implicatedin the pathogenesis of airway remodeling. Remodeling is assumed to result in persistent airflow limitation, a decrease in lung function, and airway hyperresponsiveness. Asthmatic subjects experience an accelerated decrease in lung function compared with healthy subjects, which is proportionally related to the duration and severity of their disease. (J Allergy Clin Immunol 2011;128:451-62.)