Kraft M, Djukanovic R, Wilson S, Holgate S T, Martin R J
Department of Medicine, National Jewish Center for Immunology and Respiratory Medicine, Denver, Colorado, USA.
Am J Respir Crit Care Med. 1996 Nov;154(5):1505-10. doi: 10.1164/ajrccm.154.5.8912772.
As physiologic and autopsy evidence suggests that peripheral airways and parenchyma are involved in asthma, we hypothesized that significant alveolar tissue inflammation is present in patients with stable, chronic asthma. Eleven patients with nocturnal asthma (NA) and 10 patients with non-nocturnal asthma (NNA) were studied. Each subject underwent two bronchoscopies with proximal airway endobronchial and distal alveolar tissue transbronchial biopsy in a random order at 4:00 P.M. and 4:00 A.M. Morphometric analysis was used to determine the number per volume (Nv) of inflammatory cells. Between-group comparisons showed that the Nv of eosinophils was greater in the NA alveolar tissue 4:00 A.M. compared with the subjects with NNA (40.2 x 10(3) [26.4-57.1 x 10(3), IQ] versus 15.7 x 10(3) [2.1-35.2 x 10(3), IQ], p = 0.05). In regard to the airway biopsies, no difference in the inflammatory and epithelial cells between the two groups was seen at either time. The NA group exhibited greater eosinophils and macrophages in the alveolar tissue at 4:00 A.M. compared with 4:00 P.M. (40.2 x 10(3) [26.4-57.1 x 10(3), IQ] versus 10.3 x 10(3) [2.7-16.8 x 10(3), IQ], p = 0.016 for eosinophils and 215.1 x 10(3) [129.9-356.1 x 10(3), IQ] versus 166.3 x 10(3) [150.7-212.6 x 10(3), IQ], p = 0.031 for macrophages). Only alveolar tissue eosinophils, not proximal airway tissue eosinophils, correlated with the nocturnal decrement in lung function (r = -0.54, p = 0.03). These findings suggest that eosinophils and macrophages accumulate to a greater extent in the alveolar tissue and these changes contribute more to the variation in lung function compared with inflammation in the more proximal tissue.
由于生理学和尸检证据表明外周气道和实质参与了哮喘的发病过程，我们推测在稳定的慢性哮喘患者中存在显著的肺泡组织炎症。我们对11例夜间哮喘（NA）患者和10例非夜间哮喘（NNA）患者进行了研究。每位受试者在下午4点和凌晨4点随机接受两次支气管镜检查，分别进行近端气道支气管内活检和远端肺泡组织经支气管活检。采用形态计量分析来确定炎症细胞的每体积数量（Nv）。组间比较显示，凌晨4点时，NA组肺泡组织中嗜酸性粒细胞的Nv高于NNA组（40.2×10³[26.4 - 57.1×10³，四分位数间距]对15.7×10³[2.1 - 35.2×10³，四分位数间距]，p = 0.05）。关于气道活检，两组在任何一个时间点的炎症细胞和上皮细胞均无差异。与下午4点相比，NA组凌晨4点时肺泡组织中的嗜酸性粒细胞和巨噬细胞更多（嗜酸性粒细胞：40.2×10³[26.4 - 57.1×10³，四分位数间距]对10.3×10³[2.7 - 16.8×10³，四分位数间距]，p = 0.016；巨噬细胞：215.1×10³[129.9 - 356.1×10³，四分位数间距]对166.3×10³[150.7 - 212.6×10³，四分位数间距]，p = 0.031）。只有肺泡组织中的嗜酸性粒细胞，而非近端气道组织中的嗜酸性粒细胞，与肺功能的夜间下降相关（r = -0.54，p = 0.03）。这些发现表明，与近端组织中的炎症相比，嗜酸性粒细胞和巨噬细胞在肺泡组织中积累的程度更大，并且这些变化对肺功能变化的影响更大。
