Yamauchi Kohei, Inoue Hiroshi
Third Department of Internal Medicine, Iwate Medical University School of Medicine, Iwate, Japan.
Allergol Int. 2007 Dec;56(4):321-9. doi: 10.2332/allergolint.R-07-151. Epub 2007 Nov 1.
Airway remodeling in asthma is characterized by goblet cell hyperplasia, subepithelial fibrosis, and hyperplasia and hypertrophy of airway smooth muscle cells. The airway wall thickness increases because of subepithelial fibrosis, and hyperplasia and hypertrophy of the airway smooth muscle cells and submucosal glands. Airway remodeling, therefore, can often cause irreversible airflow limitation and an increase of airway hyperresponsiveness. Recent studies have described the molecular and cellular mechanisms of collagen deposition in the airway wall such as subepithelial fibrosis. Fibroblasts or myofibroblasts play a critical role in the exaggerated deposition of collagen in asthmatic airways. Bone marrow derived fibroblasts may play a role in fibrotic remodeling in asthmatic airways. Airway remodeling is induced by cytokines and mediators produced in chronic allergic airway inflammation. Since, once formed, remodeling is resistant to asthma therapy, early intervention with inhaled corticosteroid should be considered to prevent the progress of airway remodeling.
哮喘中的气道重塑表现为杯状细胞增生、上皮下纤维化以及气道平滑肌细胞的增生和肥大。由于上皮下纤维化、气道平滑肌细胞和黏膜下腺体的增生及肥大,气道壁厚度增加。因此,气道重塑常可导致不可逆的气流受限和气道高反应性增加。最近的研究描述了气道壁胶原沉积的分子和细胞机制,如上皮下纤维化。成纤维细胞或肌成纤维细胞在哮喘气道中胶原的过度沉积中起关键作用。骨髓来源的成纤维细胞可能在哮喘气道的纤维化重塑中发挥作用。气道重塑由慢性过敏性气道炎症中产生的细胞因子和介质诱导。由于一旦形成,重塑对哮喘治疗具有抗性,因此应考虑早期吸入糖皮质激素干预以防止气道重塑的进展。
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