Jeffery P K, Wardlaw A J, Nelson F C, Collins J V, Kay A B
Department of Lung Pathology, National Heart and Lung Institute, London, England, U.K.
Am Rev Respir Dis. 1989 Dec;140(6):1745-53. doi: 10.1164/ajrccm/140.6.1745.
Little is known of the structural changes in mild asthma. We have studied the light and electron microscopic structure of lobar bronchial biopsies taken at fiberoptic bronchoscopy from 11 atopic asthmatics, four of whom were symptomatic and seven of whom were asymptomatic. The former and three of the latter had bronchial hyperresponsiveness to methacholine (PC20 less than 4 mg/ml). Quantitative comparisons were made with biopsies from ten control subjects with normal airway reactivity; five had hay fever and five were nonatopic healthy volunteers. Complete absence of surface epithelium was found in three cases of symptomatic asthma, and stratified squamous epithelium was present in the fourth. A biopsy from one of the healthy control subjects had also lost its surface epithelium. The degree of epithelial loss in all subjects correlated with the degree of airway reactivity (rs = 0.67, p less than 0.001). The reticular lamina of the epithelial basement membrane showed a trend toward thickening in the seven hyperreactive asthmatics (p less than 0.001: median test). There was a tendency to high numbers of inflammatory cells in the lamina propria, but not in the submucosa, of asthmatics, but the differences between groups did not achieve statistical significance. There were significant alterations (px2 less than 0.001) in the proportions of each type of inflammatory cell found in the lamina propria and submucosa of symptomatic asthmatics: an increase of irregularly shaped lymphocytes contributed most to the observed alteration. Where surface epithelium was present, intraepithelial lymphocytes formed the major proportion of intraepithelial "migratory" cells: 64% in normal control subjects, 78% in subjects with hay fever, and 87% in asymptomatic asthmatics.(ABSTRACT TRUNCATED AT 250 WORDS)
对于轻度哮喘的结构变化，人们了解甚少。我们研究了11例特应性哮喘患者在纤维支气管镜检查时获取的叶支气管活检标本的光镜和电镜结构，其中4例有症状，7例无症状。前4例中有3例以及后7例中的3例对乙酰甲胆碱有支气管高反应性（PC20小于4mg/ml）。与10例气道反应性正常的对照受试者的活检标本进行了定量比较；5例有花粉症，5例为非特应性健康志愿者。在3例有症状的哮喘患者中发现完全没有表面上皮，第4例有复层鳞状上皮。1例健康对照受试者的活检标本也失去了表面上皮。所有受试者的上皮丢失程度与气道反应性程度相关（rs = 0.67，p小于0.001）。在7例高反应性哮喘患者中，上皮基底膜的网状层有增厚趋势（p小于0.001：中位数检验）。哮喘患者的固有层有炎症细胞数量增多的趋势，但黏膜下层没有，不过组间差异未达到统计学显著性。有症状哮喘患者的固有层和黏膜下层中每种炎症细胞的比例有显著改变（pχ2小于0.001）：形状不规则的淋巴细胞增多对观察到的改变起了主要作用。在有表面上皮的地方，上皮内淋巴细胞构成上皮内“游走”细胞的主要部分：正常对照受试者中为64%，花粉症患者中为78%，无症状哮喘患者中为87%。（摘要截短于250词）
