Ohtami H
First Department of Internal Medicine, Kyorin University, School of Medicine.
Kansenshogaku Zasshi. 1995 May;69(5):553-67. doi: 10.11150/kansenshogakuzasshi1970.69.553.
It has scarcely been known that the pathogenetic role of mucoid Pseudomonas aeruginosa being colonised on the airway surface in diffuse panbronchiolotis DPB. The role of alginate, a main component of mucoid substance of Pseudomonas aeruginosa was demonstrated in reference to DPB. 1. Clinical Observation Serum titer of anti-alginate antibody IgG in the group of Pseudomonas-positive DPB was higher than that of the groups of Pseudomonas-negative DPB (p < 0.01) and healthy volunteers (p < 0.01). The concentration of immune complex in Pseudomonas-positive DPB group at serum level was also higher than that of the above two groups (p < 0.01), and it was well correlated between activity in the patient's symptom and the patient's prognosis. 2. Experimental Observation In the immunised mice made by free alginate injections, a lymphocyte infiltration around small vessels and small airways in lung was characteristically found at the early stage after the inhalation with mucoid Pseudomonas aeruginosa PT1252. It disappeared 14-15 days after the inhalation. By repeating the inhalation for 6 days, such a lymphocyte infiltration had been persisted and lymphocyte granulomatous change was formed around small airways. The transformation and narrowing of the small airway occurred by lymphocyte granulomatous change. At the same time, some degree of neutrophil infiltration into the airway was also observed. These findings were closely similar to that of human diffuse panbronchiolitis. 3. Conclusive Words From the above, the pathogenetic role of alginate in mucoid Psuedomonas aerginosa colonised on airway surface in DPB patient will be explained as follows. Local immunoreaction of antigen and antibody through alginate evolved lymphocyte infiltration around small airway area. A persistent localization of antigen (alginate) makes such an immunoreaction repeat. Consequently, lymphocyte-granulomatous change is formed around the small airway. On the other hand, a state of excess antigen introduced by long term colonization of mucoid Pseudomonas aeruginosa forms an immune complex in the host side. Neutrophil combined with the immune complex deposited on the airway surface may act in a destructive manner for the lung tissue of DPB patient.
在弥漫性泛细支气管炎（DPB）中，黏液型铜绿假单胞菌在气道表面定植的致病作用几乎不为人所知。关于DPB，已证实了藻酸盐（铜绿假单胞菌黏液物质的主要成分）的作用。1. 临床观察 铜绿假单胞菌阳性的DPB组中抗藻酸盐抗体IgG的血清滴度高于铜绿假单胞菌阴性的DPB组（p<0.01）和健康志愿者组（p<0.01）。血清水平上铜绿假单胞菌阳性的DPB组中免疫复合物的浓度也高于上述两组（p<0.01），且其与患者症状的活动度及患者预后密切相关。2. 实验观察 在通过注射游离藻酸盐免疫的小鼠中，在用黏液型铜绿假单胞菌PT1252吸入后早期，在肺的小血管和小气道周围特征性地发现淋巴细胞浸润。吸入后14 - 15天消失。通过重复吸入6天，这种淋巴细胞浸润持续存在，并且在小气道周围形成淋巴细胞肉芽肿性改变。小气道因淋巴细胞肉芽肿性改变而发生变形和狭窄。同时，还观察到一定程度的中性粒细胞浸润到气道中。这些发现与人类弥漫性泛细支气管炎的表现非常相似。3. 结论 综上所述，藻酸盐在DPB患者气道表面定植的黏液型铜绿假单胞菌中的致病作用可解释如下。通过藻酸盐的抗原和抗体的局部免疫反应导致小气道区域周围淋巴细胞浸润。抗原（藻酸盐）的持续定位使这种免疫反应重复发生。因此，在小气道周围形成淋巴细胞肉芽肿性改变。另一方面，黏液型铜绿假单胞菌长期定植引入的过量抗原状态在宿主侧形成免疫复合物。与沉积在气道表面的免疫复合物结合的中性粒细胞可能对DPB患者的肺组织起破坏作用。
