小剂量阿奇霉素对稳定期老年慢性阻塞性肺疾病患者外周血内TNF-α、IL-8、CRP水平及肺功能的影响

中国药物警戒 ›› 2016, Vol. 13 ›› Issue (8): 460-463.

小剂量阿奇霉素对稳定期老年慢性阻塞性肺疾病患者外周血内TNF-α、IL-8、CRP水平及肺功能的影响

李涛, 刘向群^*, 刘景双

徐州第一人民医院,江苏徐州 221002

收稿日期:2016-09-14 修回日期:2016-09-14 出版日期:2016-08-20 发布日期:2016-09-14
通讯作者: 刘向群,男,硕士,主任医师,慢性阻塞性肺疾病的临床诊治。E-mail: hxlxq68@sina.com

Effects of Low Dose Azithromycin on TNF-α, IL-8, CRP Levels in Peripheral Blood and Pulmonary Function of Elderly Patients with Stable Stage of Chronic Obstructive Pulmonary Disease

LI Tao, LIU Xiang-qun^*, LIU Jing-shuang

First People’s Hospital of Xuzhou, Jiangsu Xuzhou 221002, China

Received:2016-09-14 Revised:2016-09-14 Online:2016-08-20 Published:2016-09-14

摘要/Abstract

摘要： 目的探讨小剂量阿奇霉素对老年慢性阻塞性肺疾病（COPD）稳定期患者肺功能及外周血炎性因子的影响。方法选取2013年1月至2015年12月我院呼吸科收治的100例COPD患者作为研究对象,随机将其分为对照组和观察组各50例,对照组患者行扩张支气管药和祛痰药等COPD常规治疗方案,观察组患者于对照组基础上增加小剂量阿奇霉素口服治疗。观察并记录两组患者治疗前及治疗6个月后第一秒用力呼气容积（FEV₁）、一秒率（FEV₁/FVC）、第一秒用力呼气容积占预计值百分比（FEV₁%）等肺功能指标和肿瘤坏死因子α（TNF-α）、白细胞介素-8（IL-8）、C-反应蛋白（CRP）等外周血炎性因子及动脉血氧分压（PaO₂）及痰标本病原菌耐药性的变化情况。结果与治疗前比,治疗6个月后观察组患者的PaO₂、FEV₁、FEV₁/FVC及FEV₁%明显升高（P <0.05）,外周血炎性因子TNF-α、IL-8及CRP明显降低,差异具有统计学意义（P <0.05）。与对照组相比,治疗6个月后观察组患者的PaO₂、FEV₁、FEV₁/FVC及FEV₁%等肺功能指标和外周血炎性因子指标均得到了显著改善,比较差异有统计学意义（P<0.05）。两组患者治疗前、治疗6个月后痰标本病原菌及阿奇霉素最小抑菌浓度（MIC）比较,差异无统计学意义（P>0.05）。结论小剂量阿奇霉素用于稳定期老年COPD患者可明显改善肺功能并降低气道炎症反应,值得进一步临床推广。

关键词: 慢性阻塞性肺疾病, 小剂量阿奇霉素, 炎性因子, 肺功能

Abstract: Objective To investigate the effects of low dose azithromycin on TNF-α, IL-8, CRP levels in peripheral blood and pulmonary function of elderly patients with stable stage of chronic obstructive pulmonary disease (COPD). Methods From January 2013 to December 2015, 100 patients with COPD in our hospital were involved in the study and randomly divided into two groups, including 50 cases who received conventional bronchiectasis and expectorant medicine as the control group, while 50 patients who received conventional therapy with supplementary low dose azithromycin as the observation group. Forced vital capacity in 1st second (FEV₁), forced vital capacity (FVC), percentage of forced vital capacity in 1st second (FEV₁%), tumor necrosis factor-α (TNF-α), interleukin-8 (IL-8), C-reactive protein (CRP) and arterial oxygen partial pressure (PaO₂) were observed and recorded. Results Compared with the indexes before treatment, the PaO₂, FEV₁, FEV₁/FVC and FEV₁% were significantly higher, and the TNF-α, IL-8 and CRP were significantly lower after 6 months treatment in the observation group (P < 0.05). Compared with the control group, the indexes of pulmonary function and inflammatory factors in peripheral blood in the observation group were significantly improved after 6 months treatment, with statistically significant difference (P < 0.05). There was no significant difference between the two groups of MIC value of pathogenic bacteria and azithromycin in sputum samples before treatment and after treatment for 6 months (P >0.05). Conclusion Low dose azithromycin can significantly improve pulmonary function and reduce airway inflammation in elderly patients with stable stage of COPD, which is worthy of further clinical promotion.

Key words: chronic obstructive pulmonary disease, low dose azithromycin, inflammatory factor, pulmonary function

中图分类号:

R969

李涛, 刘向群, 刘景双. 小剂量阿奇霉素对稳定期老年慢性阻塞性肺疾病患者外周血内TNF-α、IL-8、CRP水平及肺功能的影响[J]. 中国药物警戒, 2016, 13(8): 460-463.

LI Tao, LIU Xiang-qun, LIU Jing-shuang. Effects of Low Dose Azithromycin on TNF-α, IL-8, CRP Levels in Peripheral Blood and Pulmonary Function of Elderly Patients with Stable Stage of Chronic Obstructive Pulmonary Disease[J]. Chinese Journal of Pharmacovigilance, 2016, 13(8): 460-463.

参考文献

[1] Tian, Yange, Jiansheng, et al. Effects of therapies for regulating and reinforcing lung and kidney on osteoporosis in rats with chronic obstructive pulmonary disease[J]. Journal of Traditional Chinese Medicine,2015,35（2）: 175-183.
[2] 郭洁, 武蕾, 田振峰,等. 温肾化痰配方颗粒对COPD稳定期患者肺功能与生活质量的影响[J]. 南京中医药大学学报,2013, 29（6）: 596-8.
[3] Knobloch J, Wahl C, Feldmann M, et al. Resveratrol Attenuates the
Release of Inflammatory Cytokines from Human Bronchial Smooth Muscle Cells Exposed to Lipoteichoic Acid in Chronic Obstructive Pulmonary Disease[J]. Basic & Clinical Pharmacology & Toxicology, 2014,114（2）: 202-209.
[4] Zhang L, Su Z, Zhang Z, et al. Effects of Azithromycin on Gene Expression Profiles of Proinflammatory and Anti-inflammatory Mediators in the Eyelid Margin and Conjunctiva of Patients With Meibomian Gland Disease[J]. Jama Ophthalmology,2015,133（10）: 1329-1334.
[5] 殷少军. 用最新指南指导老年COPD诊治[C]// 全国老年医学进展学术会议暨江苏省中西医结合学会老年分会学术年会.江苏：江苏省中西医结合学会老年分会,2015.
[6] 牟江, 桂天绪, 万礼,等. 沙美特罗替卡松粉吸入剂治疗中度COPD稳定期的临床研究[J]. 临床肺科杂志,2014,19（3）: 444-447.
[7] Giamarellos-Bourboulis E J. Macrolides beyond the conventional antimicrobials: a class of potent immunomodulators[J]. International Journal of Antimicrobial Agents,2008,31（1）: 12-20.
[8] 欧立文, 卢平. 低剂量阿奇霉素对慢性阻塞性肺疾病稳定期患者气道中肿瘤坏死因子-α的影响及疗效[J]. 中国老年学杂志, 2014,34（3）: 656.
[9] 赵仁国, 张鸣华, 慈晓,等. 阿奇霉素对慢性阻塞性肺疾病稳定期患者肺功能及细胞因子的影响[J]. 浙江实用医学,2013, 18（6）: 388-390.
[10] Uzun S, Djamin R S, Kluytmans J, et al. Influence of macrolide maintenance therapy and bacterial colonisation on exacerbation frequency and progression of COPD (COLUMBUS): Study protocol for a randomised controlled trial[J]. Trials,2012,13（1）: 1-7.
[11] Hodge S, Hodge G, Holmes M, et al. Increased CD8 T‐cell granzyme B in COPD is suppressed by treatment with low‐dose azithromycin[J]. Respirology,2015,20（1）: 95-100.
[12] 吴心宏, 樊昊. 长期小剂量阿奇霉素治疗稳定期 COPD 的临床疗效观察[J]. 临床肺科杂志,2013,18（4）: 649-651.
[13] Woodruff P G, Chatila W, Connett J E, et al. Tumour necrosis factor receptor-75 and risk of COPD exacerbation in the azithromycin trial[J]. European Respiratory Journal,2014,43（1）: 295-298.
[14] Han M L K, Tayob N, Murray S, et al. Predictors of chronic obstructive pulmonary disease exacerbation reduction in response to daily azithromycin therapy[J]. American journal of respiratory and critical care medicine,2014,189（12）: 1503-1508.
[15] Wan Y, Huang Z, Jing K, et al. Azithromycin Attenuates Pulmonary Inflammation and Emphysema in Smoking-Induced COPD Model in Rats[J]. Respiratory care,2015,60（1）: 128-134.