长期小剂量红霉素对中重度COPD的影响

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）患者的肺功能、运动耐力以及气道中性粒细胞功能、炎症因子的影响。方法60例中重度COPD随机分为红霉素组（30例．红霉素1日250mg）和对照组（30例，1日安慰剂1片）．对治疗前和治疗后第三、六个月进行各项指标的比较．所有的患者均保持原有治疗不变。入选患者测量肺功能、6分钟步行距离（6MWD）、诱导排痰测定痰中白细胞总数计数、痰和血中的中性粒细胞弹性蛋白酶（NE）和B2整合素（CD11b／CDl8）的浓度。结果红霉素治疗后①肺功能：与对照组比较，红霉素组在治疗第三、六个月束深吸气量（IC）均提高（两者P〈0．05）。②红霉素组在治疗第六月末与治疗前比较6MWD显著提高（371．29±70．59m vs350．33±69．75m，P〈0．05）。③红霉素组在治疗第三个月末、治疗第六个月末与治疗前相比诱导痰白细胞总数降低（两者P〈0．05）。④红霉素组在治疗第六月末与治疗前比较痰和血NE浓度均显著降低（两者P〈0．05）．⑤治疗第三个月末、治疗第六个月末与治疗前比较中性粒细胞CD11b／CD18表达明显下降（两者P〈0．05）。结论长期小剂量红霉素治疗中、重度稳定期COPD患者可以减少中性粒细胞的数量，抑制其活化；提高肺深吸气量（IC）和运功耐力，一定程度改善生活质量。

Effect of Low-dose Erythromycin on Patients with stable chronic obstructive pulmonary disease

OBJECTIVE To understand the effects of long-term treatment with low-dose erytbromycin on Pulmonary function, exercise tolerance, and air way neutrophil function in stable chronic obstructive pulmonary disease. METHODS A total of sixty subjects with moderate-to-severe stable COPD were recruited. They were divid ed in to two groups, erythromycin group（n = 30）and control group（n = 30）. All subjects with COPD were required to Continue their previous treatment. Erythromycin （250mg·d^-1） was added on those patients of erythromycin group. All subjects were measured pulmonary function and six-minute walking distanee（6MWD）. The total leucocyte counts were measured in induced sputum. The concentrations of neutrophil elastase （NE） in the sputum supernate and blood were respective detected. The CD11 expression in leucocyte were also detected. RESULTS Compared With these parameters before treatment, the erythromycin group inspiratory capacity （IC） was higher, Erythromycin therapy can significantly increase 6MWD after six mon ths（371.29 ± 70.59m vs 350.33.41 ± 69.75m, P 〈 0.05）. At the end of three or six months, sputum leucocyte total counts were significantly Induced in subjects with erythromycin. The concentrations of NE in sputum or blood were significantly lower Than their pretreatment concentrations （both P 〈 0.05）.The expression of CD11 were significantly reduced after three or six months of erythromycin therapy （both P 〈 0.01）.CONCLUSION Long-term low-dose erythromycin therapy can reduce air way neutrophil counts and inhibit activity of neutrophils and improve qualityof lifein pations with moderate-to-severe stable COPD