哮喘与慢性支气管炎的定量病理学比较研究

Comparative morphometrical study of pathology between asthma and chronic bronchitis

目的：探讨哮喘的炎症学说，并比较支气管哮喘（简称哮喘）与慢性支气管炎（简称慢支）气道炎症的病理异同。方法：经纤支镜行大气道粘膜活检将１４例哮喘和１３例慢支病人支气管粘膜活检组织以及５例无呼吸病史的意外死亡者尸体解剖的相应部位气道粘膜组织，通过常规病理切片，进行显微镜下双盲观察，采用多指标的定量病理计分及统计学处理，进行比较研究。其中８例哮喘、８例慢支进行了电镜观察。结果：与正常组相比，哮喘组和慢支组气道粘膜上皮均有不同程度的损伤、增生和鳞状上皮化生（Ｐ＜００５），并且在粘膜水肿、纤维化程度和基底膜厚度方面均有明显改变（Ｐ＜００５）。哮喘与慢支相比，哮喘的基底膜明显厚于慢支（Ｐ＜００５）。哮喘与慢支均在其粘膜和粘膜下层有明显的各种炎细胞的浸润，但哮喘组的嗜酸性粒细胞和肥大细胞高于慢支组（Ｐ＜００５）。电镜下可见哮喘组有肥大细胞不同程度的脱颗粒现象，而慢支组未见到。结论：哮喘和慢支均为气道慢性炎症，但二者在临床及病理特点上存在着一定的差异，这为临床诊断和治疗哮喘提供了一定的病理学依据。

Purpose To investigate inflammation theory of asthma, distinguish the pathological nature of airway inflammation between asthma and chronic bronchitis (CB), and to provide pathological basis for clinical diagnosis and treatment. Methods By passing the fiberoptic bronchoscope into large airway airway, endobronchial biopsies were obtained in 14 subjects with asthma and 13 subjects with CB. For comparison, 5 normal bronchial autopsies were also abtained. All these samples were assessed for microscopical evidence of inflammation by assigning them scores according to the quantitation of inflammatory cell. Eight cases of asthma and eight cases of CB were observed electron microscopically. Results Comparing with normal autoposies, the airway epithelia in asthma and CB demonstrated more evidence for damage, hyperplasia and squamous metaplasia (P<005). Further more, mucosa edema, fibrosis as well as thickness of basement membrane were obvious in asthma and CB subjects. In addition, Although there were many of inflammatory cells in asthma and CB, eosinophils and mast cells made up the majority of the infiltrating cells in asthma (P<005). In asthma mast cell degranulation was observed electron microscopically in different degree, but in CB it was not observed. Conclusion Both asthma and CB are chronic airway inflammation, but there are many clinical and pathological differences between them.