Bourdin A, Serre I, Flamme H, Vic P, Neveu D, Aubas P, Godard P, Chanez P
Service des Maladies Respiratoires, Hôpital Arnaud de Villeneuve, CHU de Montpellier, Montpellier, France.
Thorax. 2004 Jun;59(6):488-93. doi: 10.1136/thx.2003.016899.
International guidelines stress the importance of accurately discriminating between asthma and chronic obstructive pulmonary disease (COPD). Although characteristic pathological features have been described for both conditions, their discriminatory power has never been systematically assessed.
Endobronchial biopsy (EBB) specimens from patients with a clear clinical diagnosis of asthma and COPD (50 per group) were examined by three pathologists in a double blind manner. They were asked to propose a pathological diagnosis of either asthma or COPD and to analyse qualitatively the most frequent abnormalities reported in the literature.
The sensitivity and specificity of EBB ranged from 36% to 48% and from 56% to 79%, respectively. Eosinophils strongly biased the pathological diagnoses in favour of asthma, whereas their estimated prevalence was similar (11-37% in asthma and 13-41% in COPD). Metaplasia (11-39% in COPD, 1-18% in asthma) and epithelial inflammation (28-61% in COPD, 11-38% in asthma) tended to be specific to COPD, whereas epithelial desquamation (80-98% in asthma, 61-88% in COPD) and basement membrane thickening (71-94% in asthma, 53-88% in COPD) tended to be associated with asthma. There was acceptable intra- and inter-observer agreement only for metaplasia and epithelial eosinophils.
Specific histopathological features of asthma and COPD probably exist, but current routine analysis procedures to assess EBB specimens are not sufficiently discriminatory. This might be rectified by improving pathological definitions.
国际指南强调准确区分哮喘和慢性阻塞性肺疾病(COPD)的重要性。尽管已描述了这两种疾病的特征性病理特征,但从未对其鉴别能力进行系统评估。
由三名病理学家以双盲方式检查临床诊断明确的哮喘和COPD患者(每组50例)的支气管内活检(EBB)标本。要求他们提出哮喘或COPD的病理诊断,并对文献中报道的最常见异常进行定性分析。
EBB的敏感性和特异性分别为36%至48%和56%至79%。嗜酸性粒细胞强烈影响病理诊断结果,使其倾向于诊断为哮喘,而其估计患病率相似(哮喘中为11%-37%,COPD中为13%-41%)。化生(COPD中为11%-39%,哮喘中为1%-18%)和上皮炎症(COPD中为28%-61%,哮喘中为11%-38%)往往是COPD特有的,而上皮脱落(哮喘中为80%-98%,COPD中为61%-88%)和基底膜增厚(哮喘中为71%-94%,COPD中为53%-88%)往往与哮喘相关。仅在化生和上皮嗜酸性粒细胞方面,观察者内和观察者间的一致性尚可接受。
哮喘和COPD可能存在特定的组织病理学特征,但目前评估EBB标本的常规分析程序鉴别能力不足。这可能通过改进病理定义来纠正。