Kuyper Laura M, Paré Peter D, Hogg James C, Lambert Rodney K, Ionescu Diana, Woods Ryan, Bai Tony R
University of British Columbia McDonald Research Laboratories, St. Paul's Hospital, Vancouver, British Columbia, Canada.
Am J Med. 2003 Jul;115(1):6-11. doi: 10.1016/s0002-9343(03)00241-9.
Case reports suggest that deaths due to asthma can occur without airway plugging. In this study, we examined the hypothesis that obstruction of the airway lumen by an exudate containing mucus and cells is a key feature of fatal asthma attacks.
We quantified airway narrowing and lumenal content in 275 airways from 93 patients with fatal asthma aged 10 to 49 years (59 white subjects and 34 Polynesian subjects, including 19 children), compared with airways from control patients who died suddenly without pulmonary diseases.
The severity of lumenal occlusion ranged from 4% to 100% in these cases, but only five airways showed less than 20% occlusion. Compared with controls, patients with asthma had more lumenal occlusion (mean [+/- SD] open lumen, 42% +/- 23% vs. 93% +/- 8%), greater mucus occlusion (28% +/- 13% vs. 5% +/- 6%), and more occlusion by cells (30% +/- 17% vs. 3% +/- 2%, all P<0.0001). Airway narrowing was greater in larger airways (P<0.0001) and older patients (P = 0.009). Greater lumen content was associated with a higher proportion of cells (P = 0.003), and cells made up a higher proportion of the exudate in the small airways (P<0.0001). Lumenal mucus was greater in younger patients with asthma (P = 0.0007) and in Polynesian patients with asthma (P = 0.04).
Airway lumenal obstruction by an exudate composed of mucus and cells is a major contributing cause of fatal asthma in most patients.
病例报告表明，哮喘致死可能在没有气道堵塞的情况下发生。在本研究中，我们检验了这样一个假设，即含有黏液和细胞的渗出物导致的气道管腔阻塞是致命性哮喘发作的关键特征。
我们对93例年龄在10至49岁的致命性哮喘患者（59名白人受试者和34名波利尼西亚受试者，包括19名儿童）的275个气道中的气道狭窄和管腔内容物进行了量化，并与无肺部疾病突然死亡的对照患者的气道进行了比较。
在这些病例中，管腔阻塞的严重程度从4%到100%不等，但只有5个气道的阻塞小于20%。与对照组相比，哮喘患者的管腔阻塞更多（平均[±标准差]开放管腔，42%±23%对93%±8%），黏液阻塞更大（28%±13%对5%±6%），细胞阻塞更多（30%±17%对3%±2%，所有P<0.0001）。较大气道（P<0.0001）和老年患者（P = 0.009）的气道狭窄更严重。更高的管腔内容物与更高比例的细胞相关（P = 0.003），并且在小气道中细胞在渗出物中所占比例更高（P<0.0001）。哮喘年轻患者（P = 0.0007）和哮喘波利尼西亚患者（P = 0.04）的管腔黏液更多。
由黏液和细胞组成的渗出物导致的气道管腔阻塞是大多数患者致命性哮喘的主要促成原因。
