Lacoste J Y, Chanez P, Paganin F, Godard P, Michel F B, Bousquet J
Service des Maladies Respiratoires, Clinique Aiguelongue, Montpellier.
Rev Mal Respir. 1991;8(6):533-41.
Our understanding of the pathogenesis of asthma has benefitted as a result of bronchial endoscopic techniques linked to studies of bronchoalveolar lavage (LBA) and bronchial biopsy. By using modern biochemical and immunohistochemical methods as well as ultrastructural studies we are better able to specify the importance of bronchial inflammation. Currently we underline the role of epithelial lesions and of intraepithelial lesions and sub-basal inflammation. The responsibility of eosinophils in the epithelial disorder has been proved in vivo by the evidence of cationic protein found both in the LBA liquid and by the tissue localisation thanks to immunological markers. An understanding of the infiltrates and of the state of cellular activation in situ constitutes an initial step in the comprehensive of inflammation; however, these studies do not yet allow us to fully understand the mechanisms of regulation and also the trigger factor in cellular dysfunction which may be the cause. The pseudo-thickening of the basal membrane and sub-epithelial fibrosis are poorly understood, but is probably involved in epithelial repair. The histopathological mechanisms which underly the bronchial aging are equally poorly understood. In the future a better understanding of these problems of neuro-inflammatory disturbances and of epithelial permeability should facilitate the therapeutic approach.
由于支气管内镜技术与支气管肺泡灌洗（LBA）和支气管活检研究相关联，我们对哮喘发病机制的理解受益匪浅。通过使用现代生化和免疫组化方法以及超微结构研究，我们能够更好地明确支气管炎症的重要性。目前，我们强调上皮病变、上皮内病变和基底膜下炎症的作用。嗜酸性粒细胞在上皮紊乱中的作用已在体内得到证实，这是通过在LBA液体中发现阳离子蛋白以及借助免疫标记物进行组织定位来证明的。了解原位浸润和细胞活化状态是理解炎症的第一步；然而，这些研究尚不能让我们完全理解调节机制以及可能是病因的细胞功能障碍的触发因素。基底膜假性增厚和上皮下纤维化了解甚少，但可能与上皮修复有关。支气管老化的组织病理学机制同样了解不足。未来，对这些神经炎症紊乱和上皮通透性问题的更好理解应有助于治疗方法的改进。
