Curull V, Orozco-Levi M, Moyes D, Balcells E, Palacio J, Lloreta J, Broquetas J M
Servei de Pneumologia. Unitat d'Endoscòpia Respiratòria. Hospital del Mar. Barcelona. España.
Arch Bronconeumol. 2002 Nov;38(11):515-22. doi: 10.1016/s0300-2896(02)75280-0.
The epithelium and airway smooth muscles of patients with chronic obstructive pulmonary disease (COPD) or bronchial asthma undergo certain structural changes that are probably related to increased expression of inflammatory molecules and cell growth factors. Studying the relation between disease and changes in bronchial smooth muscle is difficult if investigation is restricted to samples from autopsies or thoracotomies. This study was designed to evaluate the probability of obtaining bronchial smooth muscle by endoscopic bronchial biopsy in patients with COPD and from individuals with normal lung function, the relation of disease to bronchial epithelial histology, and the potential usefulness of studying airway muscle remodeling events.
Forty-two patients undergoing diagnostic fiberoptic bronchoscopy were enrolled. Bronchial biopsies were taken systematically from the lobar and segmental dividing ridges. The epithelial structure was analyzed by conventional histology. The smooth muscle was identified by immunohistochemistry (anti-desmin antibody assay) and Western-blot analysis (anti-desmin, actin and myosin antibodies).
Sixty-nine percent of the biopsies contained bronchial smooth muscle. The probability of obtaining smooth muscle was higher in segmental than in lobar biopsies (72 vs 30%, p < 0.05). This probability was unrelated to the presence of COPD or to signs of epithelial inflammation. The fragments allowed us to use electrophoresis to identify protein structures (myosin, actin, desmin) involved in muscle remodeling processes.
Endoscopic biopsy of the bronchi allows us to obtain bronchial smooth muscle samples in a large percentage of patients, particularly when performed on segmental bronchi. The technique may be useful for future studies examining the processes of airway smooth muscle remodeling.
慢性阻塞性肺疾病（COPD）或支气管哮喘患者的上皮和气道平滑肌会发生某些结构变化，这可能与炎症分子和细胞生长因子表达增加有关。如果研究仅限于尸检或开胸手术的样本，那么研究疾病与支气管平滑肌变化之间的关系就很困难。本研究旨在评估通过内镜支气管活检从COPD患者和肺功能正常个体中获取支气管平滑肌的可能性、疾病与支气管上皮组织学的关系以及研究气道肌肉重塑事件的潜在用途。
纳入42例行诊断性纤维支气管镜检查的患者。从叶间和段间嵴系统地采集支气管活检标本。通过传统组织学分析上皮结构。通过免疫组织化学（抗结蛋白抗体检测）和蛋白质印迹分析（抗结蛋白、肌动蛋白和肌球蛋白抗体）鉴定平滑肌。
69%的活检标本含有支气管平滑肌。段支气管活检获取平滑肌的概率高于叶支气管活检（72%对30%，p<0.05）。该概率与COPD的存在或上皮炎症迹象无关。这些组织碎片使我们能够利用电泳鉴定参与肌肉重塑过程的蛋白质结构（肌球蛋白、肌动蛋白、结蛋白）。
支气管内镜活检能在很大比例的患者中获取支气管平滑肌样本，尤其是在段支气管进行活检时。该技术可能对未来研究气道平滑肌重塑过程有用。
