The effect of age and duration of disease on airway structure in fatal asthma
The effect of age and duration of disease on airway structure in fatal asthma
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DOI：
10.1164/ajrccm.162.2.9907151
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发表时间：
2000-08-01
影响因子：
24.7
通讯作者：
Weir, TD
中科院分区：
文献类型：
--
作者：
Bai, TR;Cooper, J;Weir, TD
我们假设，如果气道重塑与哮喘的持续时间有关，那么当严重程度匹配时，老年人的气道应该比年轻人的气道表现出更大的改变。使用标准形态测量技术，我们比较了死于哮喘的年轻个体（n = 14，范围17-23岁）和患有致命性哮喘的老年个体（n = 13，范围40-49岁）的基底膜周长（Pbm）在2和10 mm之间的气道。还与年龄匹配的成人的正常气道进行了比较。与年轻的致命性哮喘患者相比，老年致命性哮喘患者的室壁面积增加，主要是由于外膜面积更大，而年轻致命性哮喘患者的室壁面积与对照组无差异。在哮喘患者的肌肉束中，单个细胞周围的结缔组织基质增加，与年龄无关。在对这一变化进行校正后，两个哮喘组的平滑肌面积仍然大于年龄匹配的对照组，在患有致命性哮喘的老年人中是4倍（p = 0.04），在患有致命性哮喘的年轻人中是2倍（p = 0.03）。与年轻人相比，患有致命性哮喘的老年人的气道狭窄程度更高，两组患者的气道狭窄程度均高于对照组。两个哮喘组的管腔内阻塞和上皮下胶原蛋白明显高于对照组，但没有年龄效应。这些数据为以下假设提供了支持：随着严重哮喘持续时间的增加或年龄的增加，气道壁面积（包括平滑肌）和气道狭窄增加。观察结果表明，总壁厚度在年轻人与年轻的致命性哮喘并不大于对照组表明，在这个年龄组的致命性攻击的发病机制，而不是气道壁的几何形状的其他因素。
We hypothesized that if airway remodeling is related to duration of asthma, that when matched for severity, the airways of older adults should show greater alterations than the airways of younger adults. Using standard morphometric techniques, we compared airways with basement membrane perimeters (Pbm) between 2 and 10 mm from young individuals who died of asthma (n = 14, range 17-23 yr), and older individuals with fatal asthma (n = 13, range 40-49 yr). Comparisons were also made with normal airways from age-matched adults. Wall area was increased in old individuals with fatal asthma compared with young individuals with fatal asthma, primarily due to greater adventitial area, whereas wall area in young individuals with fatal asthma was not different from control subjects. Within muscle bundles the connective tissue matrix was increased around individual cells in individuals with asthma, unrelated to age. After adjustment for this change, smooth muscle area in both asthma groups was still greater than in age-matched control subjects, in old individuals with fatal asthma 4-fold greater (p = 0.04), and in young individuals with fatal asthma 2-fold greater (p = 0.03). Airway narrowing was increased in old versus young individuals with fatal asthma, with both groups more narrowed than control subjects. Intralumenal obstruction and subepithelial collagen in the two asthma groups were significantly greater than in control subjects, but there was no age effect. These data provide support for the hypothesis that there is an increase in airway wall area, including smooth muscle, and airway narrowing with increasing duration of severe asthma or with older age. The observation that total wall thickness was not greater in young individuals with young fatal asthma than in control subjects suggests that factors other than airway wall geometry contribute to the pathogenesis of fatal attacks in this age group.