Sugita Minoru, Kuribayashi Kozo, Nakagomi Takayuki, Miyata Shigeru, Matsuyama Tomohiro, Kitada Osamu
Medical Imaging Center, Hyogo College of Medicine, Hyogo.
Intern Med. 2003 Aug;42(8):636-43. doi: 10.2169/internalmedicine.42.636.
The international consensus report on diagnosis and treatment of asthma was published in 1992 (Clin Exp Allergy 22: 1-72). According to the report, asthma is a chronic inflammatory disorder of the airways in which many cells play a role, including mast cells and eosinophils. Airway inflammation causes various symptoms of asthma which are usually associated with widespread but variable airflow obstruction and causes an associated increase in airway responsiveness to a variety of stimuli. The definition of asthma, provided in this report, is an epoch-making revision of the conventional recognition of asthma based on respiratory physiology and does not contradict the empirical knowledge that asthma responds well to steroid therapy. One reason, which led airway inflammation to be understood as a major factor in the pathophysiology of asthma is the technological advance and the widespread use of bronchoscopes. The use of bronchoscopy as a research tool has markedly improved the understanding of the pathology of asthma. It became also possible to link biopsy findings to autopsy findings in patients who died of asthma. However, it is relatively difficult to repeat a biopsy of the airway mucosal membranes in individual asthmatic patients. Here, animal models of asthma play a significant role. Findings from animal models can provide a clue for the development of new anti-asthmatic drugs. This paper will deal with the paradigm of allergic asthma and focus on recent topics of interleukin (IL)-4 and IL-5, which seem to play a central role in allergic asthma. The causative relationship between airway inflammation and hyperresponsiveness will be discussed.
关于哮喘诊断与治疗的国际共识报告于1992年发表（《临床与实验过敏》22: 1 - 72）。根据该报告，哮喘是一种气道慢性炎症性疾病，其中许多细胞发挥作用，包括肥大细胞和嗜酸性粒细胞。气道炎症会引发哮喘的各种症状，这些症状通常与广泛但可变的气流阻塞相关，并导致气道对多种刺激的反应性增加。本报告中给出的哮喘定义，是基于呼吸生理学对哮喘传统认识的划时代修订，且与哮喘对类固醇疗法反应良好这一经验性认识并不矛盾。气道炎症被理解为哮喘病理生理学主要因素的一个原因是技术进步以及支气管镜的广泛使用。将支气管镜用作研究工具显著增进了对哮喘病理学的理解。对于死于哮喘的患者，还能够将活检结果与尸检结果联系起来。然而，在个体哮喘患者中重复进行气道黏膜活检相对困难。在此，哮喘动物模型发挥着重要作用。动物模型的研究结果可为新型抗哮喘药物的研发提供线索。本文将探讨过敏性哮喘的范式，并聚焦于白细胞介素（IL）-4和IL-5的近期研究主题，它们似乎在过敏性哮喘中起核心作用。还将讨论气道炎症与高反应性之间的因果关系。
