Cluroe A, Holloway L, Thomson K, Purdie G, Beasley R
Department of Pathology, Wellington School of Medicine, New Zealand.
J Clin Pathol. 1989 Oct;42(10):1026-31. doi: 10.1136/jcp.42.10.1026.
To determine the incidence of bronchial gland duct ectasia in fatal asthma and its association with interstitial emphysema, the histological features of 72 patients in whom death was considered to be due to asthma, and 72 matched control subjects in whom sudden death was not attributed to asthma, were reviewed. In all cases and controls, sections of two or more blocks of lung tissue stained with haematoxylin and eosin were obtained at necropsy. Bronchial gland duct ectasia was diagnosed if there was more than one abnormally dilated epithelial lined protrusion from a bronchus, extending through the smooth muscle layer. A histological diagnosis of asthma was made if four of the five following criteria were present: mucus plugging, basement membrane thickening, epithelial shedding, submucosal eosinophil leucocyte infiltration and smooth muscle hypertrophy. A histological diagnosis of asthma was made in 53 of 72 clinical cases of fatal asthma and in five of 72 control subjects. Interstitial emphysema was present in 10 clinical cases of fatal asthma, all of whom had bronchial gland duct ectasia and a histological diagnosis of asthma. Interstitial emphysema was not observed in control subjects. It is concluded that bronchial gland duct ectasia is a common histological feature of severe asthma, and that interstitial emphysema may be consequent on rupture of these dilated gland ducts.
为了确定致命性哮喘中支气管腺管扩张的发生率及其与间质性肺气肿的关联，我们回顾了72例被认为死于哮喘的患者以及72例匹配的对照受试者（猝死并非归因于哮喘）的组织学特征。在所有病例和对照中，尸检时获取了两块或更多块用苏木精和伊红染色的肺组织切片。如果从支气管有一个以上异常扩张的上皮内衬突出物延伸穿过平滑肌层，则诊断为支气管腺管扩张。如果存在以下五个标准中的四个，则做出哮喘的组织学诊断：黏液栓形成、基底膜增厚、上皮脱落、黏膜下嗜酸性白细胞浸润和平滑肌肥大。72例致命性哮喘临床病例中有53例以及72例对照受试者中有5例做出了哮喘的组织学诊断。10例致命性哮喘临床病例存在间质性肺气肿，所有这些病例都有支气管腺管扩张且做出了哮喘的组织学诊断。对照受试者中未观察到间质性肺气肿。得出的结论是，支气管腺管扩张是重度哮喘常见的组织学特征，并且间质性肺气肿可能是这些扩张的腺管破裂的结果。
