de Magalhães Simões S, dos Santos M A, da Silva Oliveira M, Fontes E S, Fernezlian S, Garippo A L, Castro I, Castro F F M, de Arruda Martins M, Saldiva P H N, Mauad T, Dolhnikoff M
Division of Clinical Immunology and Allergy, Department of Pathology, University of Sau Paulo, Sau Paulo, Brazil.
Clin Exp Allergy. 2005 May;35(5):602-11. doi: 10.1111/j.1365-2222.2005.02235.x.
The site and distribution of inflammation in the airways of asthmatic patients has been largely investigated. Inflammatory cells are distributed in both large and small airways in asthma. It has been demonstrated that distal lung inflammation in asthma may significantly contribute to the pathophysiology of the disease. The upper airways have also been implicated in the overall asthmatic inflammation. Although it is now accepted that lung inflammation is not restricted to the intrapulmonary airways in asthma, little is known about cell distribution in the other lung compartments and their relation to the intrapulmonary airways.
We aimed to map the inflammatory process in fatal asthma (FA), from the upper airways to the lung parenchyma.
Eosinophil, neutrophil, mast cell and lymphocyte content were determined in nasal mucosa, the trachea, intrapulmonary airways and parenchyma (peribronchiolar and distal) of 20 patients with FA and 10 controls.
Eosinophil content was higher in all studied areas in FA compared with controls (P<0.02). Mast cell content was higher in the outer area of larger airways, small membranous bronchioles and in peribronchiolar parenchyma of FA compared with controls (P<0.04). CD3+, CD4+and CD20+cells showed increased content in FA intrapulmonary airways compared with controls (P<0.05). There was a positive correlation between CD4+cell content in nasal mucosa and larger airways in asthmatics. Increased neutrophil content was observed only in peribronchiolar parenchyma of FA (P=0.028).
Eosinophils present a widespread distribution within the respiratory tract in FA, from the nasal mucosa to the distal lung. The outer wall of small membranous bronchioles is the main site of inflammatory changes in FA. There is a localized distribution of alveolar inflammation at the peribronchiolar region for mast cells and neutrophils. Our findings provide further evidence of the importance of the lung periphery in the pathophysiology of FA.
哮喘患者气道炎症的部位和分布已得到大量研究。炎症细胞在哮喘患者的大气道和小气道中均有分布。已有研究表明，哮喘患者的远端肺部炎症可能对该疾病的病理生理学有显著影响。上气道也与整体哮喘炎症有关。尽管目前人们公认哮喘中的肺部炎症并不局限于肺内气道，但对于其他肺区的细胞分布及其与肺内气道的关系却知之甚少。
我们旨在描绘致命性哮喘（FA）从鼻黏膜到肺实质的炎症过程。
测定了20例FA患者和10例对照者的鼻黏膜、气管、肺内气道和实质（细支气管周围和远端）中的嗜酸性粒细胞、中性粒细胞、肥大细胞和淋巴细胞含量。
与对照组相比，FA患者所有研究区域的嗜酸性粒细胞含量均更高（P<0.02）。与对照组相比，FA患者较大气道的外周区域、小膜性细支气管和细支气管周围实质中的肥大细胞含量更高（P<0.04）。与对照组相比，FA患者肺内气道中的CD3 +、CD4 +和CD20 +细胞含量增加（P<0.05）。哮喘患者鼻黏膜和大气道中的CD4 +细胞含量之间存在正相关。仅在FA患者的细支气管周围实质中观察到中性粒细胞含量增加（P = 0.028）。
在FA患者中，嗜酸性粒细胞在呼吸道内广泛分布，从鼻黏膜到远端肺。小膜性细支气管的外壁是FA炎症变化的主要部位。肥大细胞和中性粒细胞在细支气管周围区域存在局部性的肺泡炎症分布。我们的研究结果进一步证明了肺周边在FA病理生理学中的重要性。
