BRONCHIAL BIOPSIES IN ASTHMA - AN ULTRASTRUCTURAL, QUANTITATIVE STUDY AND CORRELATION WITH HYPERREACTIVITY
BRONCHIAL BIOPSIES IN ASTHMA - AN ULTRASTRUCTURAL, QUANTITATIVE STUDY AND CORRELATION WITH HYPERREACTIVITY
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DOI：
10.1164/ajrccm/140.6.1745
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发表时间：
1989-12-01
期刊：
影响因子：
--
通讯作者：
KAY, AB
中科院分区：
文献类型：
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作者：
JEFFERY, PK;WARDLAW, AJ;KAY, AB
人们对轻度哮喘的结构变化知之甚少。我们研究了11例特应性哮喘患者在纤维支气管镜下进行的支气管活检的光镜和电镜结构，其中4例有症状，7例无症状。前者和后者3例对甲胆碱有支气管高反应（PC20 < 4 mg/ml）。与10例气道反应性正常的对照组进行了定量比较；其中5人患有花粉热，5人是非特应性健康志愿者。3例有症状的哮喘患者表面上皮完全缺失，4例可见层状鳞状上皮。一个健康对照者的活组织检查也失去了其表面上皮。所有受试者的上皮损失程度与气道反应性程度相关（rs = 0.67, p < 0.001）。7例高反应性哮喘患者上皮基底膜网状层呈增厚趋势（p < 0.001；中位数检验）。哮喘患者固有层有较多炎性细胞的倾向，而粘膜下层无较多炎性细胞，但组间差异无统计学意义。有症状哮喘患者固有层和粘膜下层各类型炎症细胞的比例均有显著变化（px2 < 0.001）；不规则形状淋巴细胞的增加是观察到的改变的主要原因。在表面上皮存在的情况下，上皮内淋巴细胞形成了上皮内“迁移”细胞的主要比例：在正常对照中为64%，在花粉热患者中为78%，在无症状哮喘患者中为87%。纤毛异常、上皮或上皮下水肿、肥大细胞、神经纤维、血管充血、红细胞外溢或血小板的出现频率无明显差异。然而，在有症状哮喘组的活检中，发现血小板与电子致密纤维物质在气道管腔边缘聚集在一起。黏液细胞增生不是无症状哮喘组或花粉热组的特征。结果支持了上皮脆性与气道高反应性密切相关的假设，并证明网状层的增厚在病情早期就开始了。有症状的哮喘患者中不规则形状淋巴细胞的出现需要进一步研究其表型特征及其在哮喘发病机制中的作用。
Little is known of the structural changes in mild asthma. We have studied the light and electron microscopic structure of lobar bronchial biopsies taken at fiberoptic bronchoscopy from 11 atopic asthmatics, four of whom were symptomatic and seven of whom were asymptomatic. The former and three of the latter had bronchial hyperresponsiveness to methacholine (PC20 < 4 mg/ml). Quantitative comparisons were made with biopsies from ten control subjects with normal airway reactivity; five had hay fever and five were nonatopic healthy volunteers. Complete absence of surface epithelium was found in three cases of symptomatic asthma, and stratified squamous epithelium was present in the fourth. A biopsy from one of the healthy control subjects had also lost its surface epithelium. The degree of epithelial loss in all subjects correlated with the degree of airway reactivity (rs = 0.67, p < 0.001). The reticular lamina of the epithelial basement membrane showed a trend toward thickening in the seven hyperreactive asthmatics (p < 0.001; median test). There was a tendency to high numbers of inflammatory cells in the lamina propria, but not in the submucosa, of asthmatics, but the differences between groups did not achieve statistical significance. There were significant alterations (px2 < 0.001) in the proportions of each type of inflammatory cell found in the lamina propria and submucosa of symptomatic asthmatics; an increase in irregularly shaped lymphocytes contributed most to the observed alteration. Where surface epithelium was present, intraepithelial lymphocytes formed the major proportion of intraepithelial "migratory" cells: 64% in normal control subjects, 78% in subjects with hay fever, and 87% in asymptomatic asthmatics. There were no obvious differences in the frequency of ciliary abnormalities or the presence of epithelial or subepithelial edema, mast cells, nerve fibers, vascular congestion, extravasation of erythrocytes, or platelets. However, platelets were found aggregated together with electron-dense fibrous material at the airway lumenal edge in biopsies of the symptomatic asthma group. Mucous cell hyperplasia was not a feature of either the asymptomatic asthma or the hay fever group. The results support the hypothesis that epithelial fragility is closely linked to airway hyperreactivity and demonstrate that thickening of the reticular lamina begins early in the condition. The appearance of irregularly shaped lymphocytes in symptomatic asthmatics requires further study to characterize their phenotype and involvement in the pathogenesis of asthma.