Cutz E, Levison H, Cooper D M
Histopathology. 1978 Nov;2(6):407-21. doi: 10.1111/j.1365-2559.1978.tb01735.x.
This study describes the histopathology and ultrastructure of bronchial mucosa in lung biopsies from two children with bronchial asthma in remission, and compares them with lung samples from two children who died in status asthmaticus. Light microscopy of all samples showed changes typical of bronchial asthma, e.g. mucus plugging, goblet cell hyperplasia, 'thickening of bronchial basement membrane', peribronchial smooth muscle hypertrophy and eosinophilic infiltration. Electron microscopy revealed that the mucus plugs consisted of moderately electron-dense floccular material containing degenerate epithelial cells, macrophages and cell fragments. The luminal surfaces of ciliated cells showed cytoplasmic blebs and abnormal cilia. Mast cells in various stages of degranulation were scattered between bronchial epithelial cells. The subepithelial hyaline layer, commonly referred to as "thickened basement membrane", consisted of collagen fibrils in plexiform arrangement. The basement membrane proper appeared intact. These electron microscopic changes, particularly the presence of mast cells and subepithelial collagen deposits, were also found in autopsy samples. This combined light and electron microscopic study shows that marked, possibly irreversible changes may be present in the lungs of patients with severe bronchial asthma, even when they are asymptomatic. These pulmonary changes could be the direct consequence of mast cell activation and the release of various mediators. No evidence of immune complex deposition was found.
本研究描述了两名缓解期支气管哮喘患儿肺活检中支气管黏膜的组织病理学和超微结构，并将其与两名死于哮喘持续状态的患儿的肺样本进行比较。所有样本的光学显微镜检查均显示出支气管哮喘的典型变化，如黏液阻塞、杯状细胞增生、“支气管基底膜增厚”、支气管周围平滑肌肥大和嗜酸性粒细胞浸润。电子显微镜检查显示，黏液栓由中等电子密度的絮状物质组成，含有变性的上皮细胞、巨噬细胞和细胞碎片。纤毛细胞的腔面显示有细胞质小泡和异常纤毛。处于不同脱颗粒阶段的肥大细胞散在于支气管上皮细胞之间。上皮下透明层，通常称为“增厚的基底膜”，由呈丛状排列的胶原纤维组成。基底膜本身看起来完整。这些电子显微镜下的变化，尤其是肥大细胞和上皮下胶原沉积的存在，在尸检样本中也有发现。这项光学显微镜和电子显微镜的联合研究表明，即使在无症状的情况下，重症支气管哮喘患者的肺部也可能存在明显的、可能不可逆转的变化。这些肺部变化可能是肥大细胞活化和各种介质释放的直接后果。未发现免疫复合物沉积的证据。
