哮喘与慢性支气管炎气道炎症的临床病理对比性研究

Study on the pathological features of airway inflammation in asthma and chronic bronchitis

目的探讨哮喘病理学特点。比较哮喘与慢性支气管炎气道炎症的病理异同。为临床上鉴别诊断提供病理形态学依据。避免盲目治疗。方法经纤维支气管镜行大气道粘膜活检，将１４例哮喘和１３例慢性支气管炎患者的支气管粘膜活检组织的病理改变，做定量计分及统计学处理并进行比较。电镜下观察肥大细胞的功能状态。结果哮喘和慢性支气管炎患者气道粘膜上皮均有损害，粘膜下层有多种炎性细胞浸润及组织结构的病理改变。但哮喘组嗜酸性粒细胞、肥大细胞计数每高倍视野依次为１６±２５，３５±２７与慢性支气管炎组（１２±１７、１１±１４）比较，差异有显著性（Ｐ＜０．０１），电镜下可见到肥大细胞脱颗粒现象。其基底膜早期增厚（Ｐ＜０．０５），平滑肌增厚为其特征性病理改变。而慢性支气管炎患者的气道粘膜病理改变则与其不同，嗜酸性粒细胞＜１．２个／ＨＰ和肥大细胞＜１１个／ＨＰ，电镜下未见到肥大细胞脱颗粒现象。结论哮喘和慢性支气管炎（包括慢性喘息型支气管炎）均为气道慢性炎症，但气道粘膜病理改变存在明显差异。气道阻力增高原因不同，是两种疾病。经纤维支气管镜大气道粘膜活检病理检查，对两种疾病的鉴别有重要的临床意义。

Objective To explore the differnece between the pathological features of asthma and chronic bronchitis on airway inflammation, then to provide pathomorphological basis for appropriate diagnosis and treatment of these two different entities. Method To compare the pathological changes of airways from 14 asthmatic and 13 chronic bronchitic patients. Result There were damaging lesions shown on tracheo bronchial epithelium of asthmatic and chronic bronchitic patients; various inflammatory cells and structural pathological changes occurred in submucosa. The numbers of eosinophilic cells and mast cells in asthmatic group were higher than those of chronic bronchitic group ( P <0.01). Thickness of basement membrane in early stage ( P <0.05) and thickness of smooth muscle were characteristic pathological changes for asthmatic group. Degranulation phenomenon of mast cells was found in asthmatic group. The pathological features of airway mucosa of chronic bronchitic group were different: eosinophilic cells <1.2/HP and mast cells<1/HP; no degranulation of mast cells was observed under electronmicroscopy. Conclusion Both asthma and chronic bronchitis (including chronic asthmatic bronchitis) are chronic airway inflammatory illnesses, but obvious pathomorphological difference was found in their airway mucosa. These are two different diseases and the reasons for causing airflow obstruction are also different.