Kraft M, Martin R J, Wilson S, Djukanovic R, Holgate S T
Department of Medicine, National Jewish Medical and Research Center and the Pulmonary Sciences and Critical Care Division, University of Colorado Health Sciences Center, Denver, Colorado, USA.
Am J Respir Crit Care Med. 1999 Jan;159(1):228-34. doi: 10.1164/ajrccm.159.1.9804033.
We have shown in nocturnal asthma that alveolar tissue eosinophils are increased at night as compared with the proximal airway, and that they correlate with the overnight decrement in lung function. As the CD4+ cell is thought to be the principal orchestrating cell in eosinophil recruitment, we evaluated its presence in the proximal and distal airways in nocturnal asthma. Eleven patients with nocturnal asthma (NA) and 10 patients with non-nocturnal asthma (NNA) underwent two bronchoscopies with proximal airway endobronchial and distal alveolar tissue transbronchial biopsy in a random order at 4:00 P.M. and at 4:00 A.M. separated by 1 wk. Immunohistochemical staining and morphometric analysis were used to determine the number of CD3+, CD4+, and CD8+ cells and EG2+ eosinophils per mm2 in the epithelium, lamina propria, and alveolar tissue. At 4:00 A.M., the NA group had a significantly greater number of CD4+ cells in the alveolar tissue than the NNA group (9.8 cells/ mm2 [5.6-30.8, interquartile (IQ)] versus 1.5 cells/mm2 [0-6. 3, IQ], p = 0.04). Within the NA group, there were significantly greater numbers of CD3+, CD4+, CD8+, and EG2+ cells in the proximal airway lamina propria than in the distal airway at both 4:00 P.M. and 4:00 A.M. There were no differences within the epithelium between the groups at either time point. Only alveolar tissue, not airway tissue, CD4+ cells correlated inversely with the percentage predicted FEV1 at 4:00 A.M. (r = -0.68, p = 0.0018) and positively with the number of alveolar tissue EG2+ cells (r = 0.66, p = 0.01). These findings suggest that the CD4+ lymphocyte is increased in the alveolar tissue at night in nocturnal asthma as compared with non-nocturnal asthma.
我们已经证明，在夜间哮喘中，与近端气道相比，肺泡组织中的嗜酸性粒细胞在夜间会增加，并且它们与夜间肺功能下降相关。由于CD4 +细胞被认为是嗜酸性粒细胞募集的主要协调细胞，我们评估了其在夜间哮喘近端和远端气道中的存在情况。11例夜间哮喘（NA）患者和10例非夜间哮喘（NNA）患者在下午4点和凌晨4点以随机顺序接受了两次支气管镜检查，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，两次检查间隔1周。采用免疫组织化学染色和形态计量分析来确定上皮、固有层和肺泡组织中每平方毫米CD3 +、CD4 +和CD8 +细胞以及EG2 +嗜酸性粒细胞的数量。凌晨4点时，NA组肺泡组织中的CD4 +细胞数量显著多于NNA组（9.8个细胞/平方毫米[5.6 - 30.8,四分位数间距（IQ）] 对比1.5个细胞/平方毫米[0 - 6.3, IQ]，p = 0.04）。在NA组中，下午4点和凌晨4点时，近端气道固有层中的CD3 +、CD4 +、CD8 +和EG2 +细胞数量均显著多于远端气道。在两个时间点，两组上皮之间均无差异。仅肺泡组织而非气道组织中的CD4 +细胞与凌晨4点时预测的FEV1百分比呈负相关（r = -0.68，p = 0.0018），与肺泡组织中EG2 +细胞数量呈正相关（r = 0.66，p = 0.01）。这些发现表明，与非夜间哮喘相比，夜间哮喘患者夜间肺泡组织中的CD4 +淋巴细胞增加。
