Tang Mimi L K, Wilson John W, Stewart Alastair G, Royce Simon G
Department of Immunology, Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne 3052, Australia.
Pharmacol Ther. 2006 Nov;112(2):474-88. doi: 10.1016/j.pharmthera.2006.05.001. Epub 2006 Jun 8.
Airway remodelling refers to the structural changes that occur in the airway wall in asthma. These include epithelial hyperplasia and metaplasia, subepithelial fibrosis, muscle cell hyperplasia and angiogenesis. These structural changes result in thickening of the airway wall, airway hyperresponsiveness (AHR), and a progressive irreversible loss of lung function. The precise sequence of events that take place during the remodelling process and the mechanisms regulating these changes remain poorly understood. It is thought that airway remodelling is initiated and promoted by repeated episodes of allergic inflammation that damage the surface epithelium of the airway. However, other mechanisms are also likely to contribute to this process. Moreover, the interrelationship between airway remodelling, inflammation and AHR has not been clearly defined. Currently, there are no effective treatments that halt or reverse the changes of airway remodelling and its effects on lung function. Glucocorticoids have been unable to eliminate the progression of remodelling changes and there is limited evidence of a beneficial effect from other available therapies. The search for novel therapies that can directly target individual components of the remodelling process should be made a priority. In this review, we describe the current understanding of the airway remodelling process and the mechanisms regulating its development. The impact of currently available asthma therapies on airway remodelling is also discussed.
气道重塑是指哮喘患者气道壁发生的结构变化。这些变化包括上皮细胞增生和化生、上皮下纤维化、肌细胞增生以及血管生成。这些结构变化导致气道壁增厚、气道高反应性（AHR）以及肺功能进行性不可逆丧失。在重塑过程中发生的精确事件序列以及调节这些变化的机制仍知之甚少。人们认为气道重塑是由反复发生的过敏性炎症发作引发和促进的，这些炎症会损害气道表面上皮。然而，其他机制也可能促成这一过程。此外，气道重塑、炎症和AHR之间的相互关系尚未明确界定。目前，尚无有效的治疗方法能够阻止或逆转气道重塑的变化及其对肺功能的影响。糖皮质激素无法消除重塑变化的进展，其他现有疗法产生有益效果的证据也有限。应优先寻找能够直接针对重塑过程各个组成部分的新型疗法。在本综述中，我们描述了目前对气道重塑过程及其发展调节机制的理解。还讨论了目前可用的哮喘疗法对气道重塑的影响。
