Kauffman H F, Tomee J F, van der Werf T S, de Monchy J G, Koëter G K
Department of Allergology, University Hospital, Groningen, The Netherlands.
Am J Respir Crit Care Med. 1995 Jun;151(6):2109-15; discussion 2116. doi: 10.1164/ajrccm.151.6.7767565.
Fungus-induced obstructive airway disease in atopic individuals can be differentiated into two categories: first, uncomplicated asthmatic reactions due to high but transient exposure to fungal spores (fungal asthma), resulting in a TH2-type response with immunoglobulin E-mediated reactions and eosinophilic inflammation; and second, a more complex asthmatic reaction due to colonization of the mucus-epithelial surface by virulent protease-producing fungi. The latter condition stimulates as exaggerated immunological response including all subclasses of antibodies directed against the microorganism and an intense eosinophilic infiltrate of the airways. The authors propose that the exaggerated inflammatory response in allergic bronchopulmonary fungosis damages epithelial cells and underlying tissue cells, resulting in inefficient elimination of the microorganisms and damage to matrix proteins of the lung tissue by proteases released by both the fungi and degranulating eosinophils. The positive effects of corticosteroids in the treatment of allergic bronchopulmonary aspergillosis probably results from the dampening of the inflammatory response and an increase of the efficiency of killing the fungi. Sensitization to fungi is high in childhood and declines rapidly with age, suggesting that younger children may be less proficient in clearing fungi from the airways. We propose that insufficient treatment of fungal asthma may result in damage to the bronchial mucosa and formation of bronchiectasis.
第一类，因短期大量接触真菌孢子而引发的单纯性哮喘反应（真菌性哮喘），导致以免疫球蛋白E介导反应和嗜酸性粒细胞炎症为特征的TH2型反应；第二类，由产毒蛋白酶的真菌在黏液上皮表面定植引起的更为复杂的哮喘反应。后一种情况会引发过度的免疫反应，包括针对该微生物的所有抗体亚类以及气道内强烈的嗜酸性粒细胞浸润。作者提出，变应性支气管肺真菌病中过度的炎症反应会损害上皮细胞和下层组织细胞，导致微生物清除效率低下，以及真菌和脱颗粒嗜酸性粒细胞释放的蛋白酶对肺组织基质蛋白的破坏。皮质类固醇在治疗变应性支气管肺曲霉病中的积极作用可能源于炎症反应的减轻以及杀灭真菌效率的提高。儿童对真菌的致敏率较高，且随年龄增长迅速下降，这表明年幼儿童可能在从气道清除真菌方面能力较差。我们认为，真菌性哮喘治疗不充分可能导致支气管黏膜受损和支气管扩张的形成。
