Tanaka Hiroshi, Yamada Gen, Saikai Toyohiro, Hashimoto Midori, Tanaka Shintaro, Suzuki Kazuhiko, Fujii Masaru, Takahashi Hiroki, Abe Shosaku
Third Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8543, Japan.
Am J Respir Crit Care Med. 2003 Dec 15;168(12):1495-9. doi: 10.1164/rccm.200306-727OC. Epub 2003 Sep 25.
Hypervascularity in the bronchial wall is part of airway remodeling, but has remained an ill-defined process in asthma pathogenesis. Previous morphologic assessment has been limited to biopsy specimens, and therefore a high-magnification bronchovideoscope (side-viewing type) was developed for less invasive examination of subepithelial vessels. We evaluated vascularity in the lower trachea, using this novel scope in 12 normal control subjects, 13 patients with chronic obstructive pulmonary disease, and 24 subjects with stable asthma; 8 were steroid naive with newly diagnosed asthma (Group A) and 16 had been treated with inhaled corticosteroids for more than 5 years (Group B). The redness of bronchial mucosa in patients with asthma observed by conventional fiberoptic bronchoscopy proved to be due to a fine vascular network. Morphometric measurements of subepithelial vessels showed that both vessel area density and vessel length density were significantly (p<0.0001) increased in subjects with asthma as compared with control subjects and patients with chronic obstructive pulmonary disease. The degree of increase in vessels did not differ between Group A and Group B. The increase in subepithelial vessels of the airway is present even in newly diagnosed asthma. This novel bronchovideoscope is useful for assessment of vessel network in the surface of the airway lumen in vivo.
支气管壁血管增多是气道重塑的一部分，但在哮喘发病机制中一直是一个定义不明确的过程。以往的形态学评估仅限于活检标本，因此开发了一种高倍支气管视频镜（侧视型）用于对上皮下血管进行侵入性较小的检查。我们使用这种新型内镜对12名正常对照者、13名慢性阻塞性肺疾病患者和24名稳定期哮喘患者的下气管血管情况进行了评估；其中8名是新诊断的未使用过类固醇的哮喘患者（A组），16名接受吸入性皮质类固醇治疗超过5年的患者（B组）。通过传统纤维支气管镜观察到的哮喘患者支气管黏膜发红被证明是由于精细的血管网络所致。上皮下血管的形态学测量显示，与对照者和慢性阻塞性肺疾病患者相比，哮喘患者的血管面积密度和血管长度密度均显著增加（p<0.0001）。A组和B组血管增加的程度没有差异。即使在新诊断的哮喘患者中，气道上皮下血管也会增加。这种新型支气管视频镜有助于在体内评估气道腔内表面的血管网络。
