Malmström Kristiina, Lohi Jouko, Sajantila Antti, Jahnsen Frode L, Kajosaari Merja, Sarna Seppo, Mäkelä Mika J
Dept. of Allergy, University of Helsinki and Helsinki University Hospital, PO Box 160, FI-00029, Helsinki, Finland.
Dept. of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Respir Res. 2017 May 16;18(1):94. doi: 10.1186/s12931-017-0575-0.
Thickening of reticular basement membrane, increased airway smooth muscle mass and eosinophilic inflammation are found in adult fatal asthma. At the present study the histopathology of fatal paediatric and adolescent asthma is evaluated.
Post-mortem lung autopsies from 12 fatal asthma cases and 8 non-asthmatic control subjects were examined. Thickness of reticular basement membrane (RBM) and percentage of airway smooth muscle (ASM%) mass area were measured and inflammatory cells were counted. Patient records were reviewed for clinical history.
The age range of the cases was from 0.9 to 19.5 years, eight were males and five had received inhaled corticosteroids. Thickened RBM was detected in majority of the cases without any correlation to treatment delay, age at onset of symptoms or diagnosis. In the large airways ASM was clearly increased in one third of the cases whereas the median ASM% did not differ from that in healthy controls (14.0% vs. 14.0%). In small airways no increase of ASM was found, instead mucous plugs were seen in fatal asthma. The number of eosinophils, plasmacytoid dendritic cells, macrophages, and B-cells were significantly increased in fatal asthma cases compared with controls and the two latter correlated with the length of the fatal exacerbation.
The findings highlight the strong presence of eosinophils and mucous plugs even in small airways in children and adolescents with fatal asthma. Thickened RBM was obvious in majority of the patients. Contrary to our hypothesis, increased ASM% was detected in only one third of the patients.
在成人致死性哮喘中发现网状基底膜增厚、气道平滑肌质量增加和嗜酸性粒细胞炎症。在本研究中，对致死性儿童和青少年哮喘的组织病理学进行了评估。
检查了12例致死性哮喘病例和8例非哮喘对照受试者的尸检肺组织。测量网状基底膜（RBM）厚度和气道平滑肌（ASM%）质量面积百分比，并对炎症细胞进行计数。查阅患者记录以了解临床病史。
病例的年龄范围为0.9至19.5岁，8例为男性，5例接受过吸入性糖皮质激素治疗。大多数病例中检测到RBM增厚，与治疗延迟、症状发作年龄或诊断无关。在大气道中，三分之一的病例ASM明显增加，而ASM%的中位数与健康对照无差异（14.0%对14.0%）。在小气道中未发现ASM增加，相反，在致死性哮喘中可见黏液栓。与对照组相比，致死性哮喘病例中的嗜酸性粒细胞、浆细胞样树突状细胞、巨噬细胞和B细胞数量显著增加，后两者与致死性加重的持续时间相关。
这些发现突出了即使在患有致死性哮喘的儿童和青少年的小气道中也强烈存在嗜酸性粒细胞和黏液栓。大多数患者的RBM增厚明显。与我们的假设相反，仅三分之一的患者检测到ASM%增加。
