Comparative morphology of the airways in asthma and chronic obstructive pulmonary disease.
Comparative morphology of the airways in asthma and chronic obstructive pulmonary disease.
复制标题
哮喘和慢性阻塞性肺疾病气道的比较形态。
DOI：
--
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发表时间：
1994
影响因子：
24.7
通讯作者：
P. Jeffery
中科院分区：
文献类型：
--
作者：
P. Jeffery
哮喘和慢性阻塞性肺疾病（COPD）是复杂的疾病，其定义不精确，因此很难进行明确的形态学比较。哮喘可分为外源性（过敏性）、内源性（晚发型）和职业性哮喘。致命性哮喘患者的气道被明显顽固的渗出物和粘液堵塞所堵塞。气道表面上皮脆弱，网状基底膜增厚，支气管血管扩张、充血、水肿。支气管平滑肌和粘膜下腺肿块增大，特别是在中等大小的支气管中。炎症浸润增加，包括活化的淋巴细胞和嗜酸性粒细胞，并释放出后者的颗粒成分；过敏性炎症与白细胞介素 IL-4 和 IL-5（即 TH2 表型）以及 GMCSF 和 TNF α 的基因表达有关。其中许多变化已经存在于轻度哮喘中。相比之下，三种情况会导致慢性阻塞性肺病：（1）在慢性支气管炎中，存在与粘液分泌过多、气管支气管粘膜下腺肿大以及酸性粘液不成比例增加相关的炎症。网状基底膜并不持续增厚。 (2)小(外周)气道疾病有巨噬细胞细支气管炎、粘液化生和增生、管腔内粘液增多、壁肌增多、纤维化和气道狭窄。呼吸性细支气管炎和肺泡壁附着物丧失是重要的病变。 (3) 肺气肿涉及肺泡壁的弹力破坏；其总体严重程度（而非类型）似乎是 COPD 气流慢性不可逆恶化的重要决定因素。
Asthma and chronic obstructive pulmonary disease (COPD) are complex conditions with imprecise definitions that make definitive morphological comparisons difficult. Asthma may be divided into extrinsic (allergic), intrinsic (late onset), and occupational forms. The airways in fatal asthma are occluded by markedly tenacious plugs of exudate and mucus; there is fragility of airway surface epithelium, thickening of the reticular basement membrane, and bronchial vessel dilatation, congestion, and edema. There is enlargement of bronchial smooth muscle and also of submucosal gland mass, particularly in medium-sized bronchi. There is increased inflammatory infiltrate comprising activated lymphocytes and eosinophils with release of granular content in the latter; the allergic inflammation is associated with gene expression for interleukins IL-4 and IL-5 (ie, TH2 phenotype) and also GMCSF and TNF alpha. Many of these changes are already present in mild forms of asthma. In comparison, three conditions contribute to COPD: (1) In chronic bronchitis there is inflammation associated with mucous hypersecretion, enlargement of tracheo-bronchial submucosal glands, and a disproportionate increase of acidic mucus. The reticular basement membrane is not consistently thickened. (2) In small (peripheral) airways disease there is a macrophage bronchiolitis, mucous metaplasia and hyperplasia, increased intraluminal mucus, increased wall muscle, fibrosis, and airway stenoses. Respiratory bronchiolitis and loss of alveolar wall attachments are important lesions. (3) Emphysema involves elastolytic destruction of the alveolar wall; its overall severity, rather than type, appears to be an important determinant of chronic irreversible deterioration of airflow in COPD.
DOI：
10.1164/ajrccm/137.1.62
发表时间：
1988
期刊：
The American review of respiratory disease
影响因子：
--
作者：
A. Wardlaw;S. Dunnette;G. Gleich;J. Collins;A. Kay
通讯作者：
A. Wardlaw;S. Dunnette;G. Gleich;J. Collins;A. Kay
影响因子：
14.2
作者：
BROIDE, DH;LOTZ, M;WASSERMAN, SI
通讯作者：
WASSERMAN, SI
DOI：
10.1164/ajrccm/148.3.713
发表时间：
1993-09-01
期刊：
AMERICAN REVIEW OF RESPIRATORY DISEASE
影响因子：
--
作者：
SUR, S;CROTTY, TB;GLEICH, GJ
通讯作者：
GLEICH, GJ