Division of Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Ann Am Thorac Soc. 2018 Nov;15(Suppl 3):S143-S148. doi: 10.1513/AnnalsATS.201802-128AW.
The lung is continuously exposed to particles, toxicants, and microbial pathogens that are cleared by a complex mechanical, innate, and acquired immune system. Mucociliary clearance, mediated by the actions of diverse conducting airway and submucosal gland epithelial cells, plays a critical role in a multilayered defense system by secreting fluids, electrolytes, antimicrobial and antiinflammatory proteins, and mucus onto airway surfaces. The mucociliary escalator removes particles and pathogens by the mechanical actions of cilia and cough. Abnormalities in mucociliary clearance, whether related to impaired fluid secretion, ciliary dysfunction, lack of cough, or the disruption of epithelial cells lining the respiratory tract, contribute to the pathogenesis of common chronic pulmonary disorders. Although mucus and other airway epithelial secretions play a critical role in protecting the lung during acute injury, impaired mucus clearance after chronic mucus hyperproduction causes airway obstruction and infection, which contribute to morbidity in common pulmonary disorders, including chronic obstructive pulmonary disease, asthma, idiopathic pulmonary fibrosis, cystic fibrosis, bronchiectasis, and primary ciliary dyskinesia. In this summary, the molecular and cellular mechanisms mediating airway mucociliary clearance, as well as the role of goblet cell metaplasia and mucus hyperproduction, in the pathogenesis of chronic respiratory diseases are considered.
肺持续暴露于颗粒、毒物和微生物病原体中，这些物质被复杂的机械、先天和获得性免疫系统清除。黏膜纤毛清除作用由不同的气道和黏膜下腺上皮细胞的作用介导，通过分泌液体、电解质、抗菌和抗炎蛋白以及黏液到气道表面，在多层次防御系统中发挥关键作用。黏液纤毛清除作用通过纤毛和咳嗽的机械作用清除颗粒和病原体。无论是与液体分泌受损、纤毛功能障碍、缺乏咳嗽还是呼吸道上皮细胞排列紊乱有关的黏液纤毛清除异常，都可能导致常见慢性肺部疾病的发病机制。尽管黏液和其他气道上皮分泌物在急性损伤期间对肺有保护作用，但慢性黏液高分泌后清除受损会导致气道阻塞和感染，这会导致常见肺部疾病的发病率增加，包括慢性阻塞性肺疾病、哮喘、特发性肺纤维化、囊性纤维化、支气管扩张症和原发性纤毛运动障碍。在这篇综述中，考虑了介导气道黏液纤毛清除的分子和细胞机制，以及杯状细胞化生和黏液高分泌在慢性呼吸道疾病发病机制中的作用。
