【摘要】 目的探讨长期应用小剂量红霉素对稳定期慢性阻塞性肺疾病(COPD)患者气道的中性粒细胞功能以及肺功能、运动耐力、呼吸症状和生活质量等临床指标的影响。方法应用前瞻、随机分组、对照的方法,将2007年1—7月在广西医科大学第一附属医院门诊及社区的36例稳定期COPD患者(Ⅱ～Ⅳ级)分为红霉素组(常规治疗+红霉素375 mg/d)和对照组(常规治疗),比较治疗前和治疗3、6个月后的各项临床指标。结果 31例稳定期COPD患者完成。(1)与对照组比较,红霉素组治疗3、6个月后痰的炎症细胞总数和中性粒细胞计数显著降低,中性粒细胞比例下降;红霉素组治疗3、6个月后痰白细胞总数和中性粒细胞计数较治疗前明显降低,治疗6个月后中性粒细胞比例下降(P<0.05)。(2)与治疗前相比,红霉素组在治疗6个月后痰和血中性粒细胞弹性蛋白酶(NE)浓度均显著降低,中性粒细胞趋化减少(P<0.05)。(3)治疗前后第一秒用力呼气容积(FEV1)、用力肺活量(FVC)均无显著差异。(4)与对照组及组内比较,红霉素组治疗6个月后6 m in步行距离(6MWD)显著提高(P<0.05)。(5)红霉素组治疗6个月后一般健康状况(GH)较治疗前提高(P<0.05),社会功能(SF)治疗3、6个月后均较治疗前提高(P<0.05);MRC呼吸困难评分在治疗前后差异无统计学意义;红霉素组6个月内急性加重次数较对照组减少(P<0.05)。结论长期小剂量红霉素治疗稳定期COPD患者可以减少痰中性粒细胞的数量,抑制其活化;提高运功耐力;减少急性加重次数,一定程度改善生活质量。更多还原

【Abstract】 Objective To study the effects of long-term treatment with low-dose erythromycin on clinical indexes such as airway neutrophil function,pulmonary function,exercise tolerance,respiratory symptoms,and life quality in patients with stable chronic obstructive pulmonary disease.Methods A total of 36 subjects with stable COPD(Ⅱ～Ⅳ) were recruited and divided into two erythromycin group(routine therapy+erythromycin 375 mg/d) and control group(routine therapy) in a prospective randomised and controlled method.All clinical parameters before treatment,three and six months later after treatment were estimated and compared.Results 31 subjects with stable COPD finished the six-month clinical trial.(1) 3 and 6 month later after treartment in erythromycin group,putum inflammatory cell count and neutrophil count reduced significantly,and neutrophil proportion also reduced(P<0.05).(2) The concentrations of neutrophil elastase(NE) both in sputum and blood significantly in erythromycin group decreased 6 months later after therapy,and the chemotaxis of neutrophils also reduced(P<0.05).(3) There were no significant differences in FEV1 and FVC before and after treatment.(4) In intragroup and intergroup comparison,six-minute walking distance(6MWD) six months after treatment in erythromycin group was significantly longer(P<0.05).(5) In the erythromycin group,patients’ general health six months after treatment showed significant improvement(P<0.05),and so were social function(SF) both three months and six months later after treatment(P<0.05);there was no significant difference in MRC score(P>0.05);erythromycin group had significantly fewer COPD exacerbations than control group six months later after treatment(P<0.05).Conclusion Long-term low-dose erythromycin therapy in patients with stable COPD may reduce airway neutrophil counts and inhibit activity of neutrophils,may improve patients’ exercise tolerance,reduce acute exacerbations,and improve quality of life.更多还原