哮喘儿童小气道功能障碍的再认识

doi:10.3969/j.issn.1674-8115.2023.04.014

摘要/Abstract

摘要：

小气道功能障碍（small airway dysfunction，SAD）广泛存在于儿童哮喘的多个阶段，以气道炎症、气道重塑、气道高反应性为基础，其中气道炎症是SAD的主要病理特征。近年来研究发现，参与小气道病变进展的免疫细胞，如2型固有淋巴细胞（type 2 innate lymphoid cell，ILC2）、巨噬细胞、粒细胞等，在哮喘相关的临床控制和靶向治疗中发挥重要的作用。同时，随着脉冲振荡技术和呼出气一氧化氮检测等临床检测技术的不断完善，SAD与儿童哮喘早期发生和发展有关的证据也越来越多。针对小气道的超细颗粒气雾剂和单克隆抗体靶向药物研制为哮喘精准控制提供了新的手段。因此，小气道在哮喘等慢性呼吸系统疾病中的功能近年来受到广泛关注。既往研究表明，SAD会增加儿童哮喘不受控制的风险，但往往易被忽视。该文从发病机制、诊断评估和治疗3个方面阐述SAD及儿童哮喘的最新研究进展，希冀为以小气道为治疗靶点的长期哮喘管理提供新的视角及认识。

关键词: 小气道功能障碍, 气道炎症, 气道重塑, 儿童, 哮喘, 哮喘控制

Abstract:

Small airway dysfunction (SAD) widely exists in different stages of childhood asthma, which is based on airway inflammation, airway remodeling and airway hyperresponsiveness. Among them, airway inflammation is the main pathological feature of SAD. It has been recently found that immune cells involved in the progression of the disease, such as type 2 innervate lymphoid cells (ILC2s), macrophages, and granulocyte, played an important role in clinical control and targeted therapy of asthma. At the same time, with continuous improvement of clinical detection technologies such as impulse oscillometry and exhaled nitric oxide detecting, more and more evidence suggests that SAD is associated with the early occurrence and development of pediatric asthma. The development of ultra-fine particle aerosol and monoclonal antibody targeting small airways has provided a new means for the precise control of asthma. Therefore, the function of small airways in chronic respiratory diseases, including asthma, has received extensive attention in recent years. Previous studies have shown that SAD increases the risk of uncontrolled asthma in children, but it is often ignored. This article describes the latest research progress of SAD and childhood asthma from the aspects of pathogenesis, diagnostic evaluation and treatment, so as to provide a new perspective and understanding for long-term asthma management targeting small airways.

Key words: small airway dysfunction (SAD), airway inflammation, airway remodeling, child, asthma, asthma control

中图分类号:

R725.6

朱思宇, 董晓艳. 哮喘儿童小气道功能障碍的再认识[J]. 上海交通大学学报（医学版）, 2023, 43(4): 500-506.

ZHU Siyu, DONG Xiaoyan. New insights in small airway dysfunction of childhood asthma[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(4): 500-506.

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