COPD急性发作时抗生素疗效的比较及与生存质量和肺功能变化的相关性研究  

Relativity Studies on Antibiotic Treating Effect and QOL and Lung Function in AECOPD

作　　者：单小云[1] 应延风[2] 胡野[2] 厉慧琴 陈宝中[2] 

机构地区：[1]浙江金华市中心医院,浙江金华321000 [2]金华职业技术学院,浙江金华321007 [3]浙江金华广福医院,浙江金华321000

出　　处：《金华职业技术学院学报》2007年第4期51-59,共9页Journal of Jinhua Polytechnic

基　　金：2004年度金华市科技局计划资助项目(2004-1-360)

摘　　要：目的:研究三类抗生素治疗(氟喹诺酮类药物—拜复乐,大环内酯族—阿奇霉素,β内酰胺类—优立新),对控制COPD急性发作(AECOPD),缩短治疗周期,对病人肺功能及生存质量的影响。方法:采用随机病例对照研究。将符合入选标准的病例随机分为:治疗组为A组(拜复乐治疗组),用拜复乐400mg每日一次顿服×5天为一疗程,B组(阿奇霉素对照组)用阿奇霉素250mg qd首剂加倍×5天、C组(优立新对照组),用优立新375mg bid×10天为一疗程,每个病例随访1年。结果:在156例患者的痰标本中,分离出病原菌106株,总阳性率67.94%,其中革兰氏阳性菌占32.08%(34/106),主要为肺炎链球菌16.04%,革兰氏阴性菌占67.92%(72/106),主要由大肠埃希菌16.04%,阴沟肠杆菌16.98%等构成。三组细菌清除率和单次治疗临床疗效比较无显著差异(P>0.05)。在一年随访期间,A组病人发作次数(人次/年)158.5±24.7显著低于B组374.5±46.8和C组368.4±38.4(P<0.01),治疗后二次间急性发作间歇A组98.5±54.4天明显长于B组38.2±12.3天和C组43.8±17.2天(P=0.001)。在A组中一年随访后SGRQ量表评分显著降低,与治疗前相比有显著差异(P<0.01)。在B和C组中治疗前后评分无显著差异。生存质量评分在治疗前无显著差异的三组病人,在一年随访后,A组病人评分显著低于B和C组(P均<0.01)。随访一年后,A组肺功能指标(FVC、FEV1、PFVC、MMF、MVV)均高于治疗前(P<0.01),而B、C组治疗前后无显著差异(P>0.05)。随访一年后,A组肺功能指标显著高于B、C组(P均<0.01)。直线回归分析表明SGRQ的症状与FEV1有直线相关(P=0.002)。结论:拜复乐对控制下呼吸道感染较为有效,能改善和延缓肺功能下降速度;改善病情的严重度,表现为急性发作次数减少和治疗后缓解期的延长,为病人肺功能恢复和改善QOL提供前提。Objective：To study three antibiotics（Fluoroquinolone antibiotic-Moxifoxacin Tablets,Macrolide antibiotics-Azithromycin Dispersible Tablets,and β-lactams antibiotics-unasyn）on controlling AECOPD effect,shortening treatment periods,and affecting on lung function and quality of life（QOL）.Methodes：Random case-control study,Patients were included in the study if they met standard criteria for the diagnosis of COPD,and to select the stable and exacerbations.Treatment：Patients were classified as three groups（A：Moxifoxacin treatment group,400mg qd×5 and B： Azithromycin matched group,250mg qd×5 and C： unasyn matched group,375mg bid×10）,followed for 1 year.Result： Totally 156 phlegm samples were tested and 106 of them had bacteria,the positive rate was 67.94%.From them,the positive rate in Gram-positive cocci was 32.08%（34/106）.Streptococcus pneumonia was 16.04% and in Gram-negative bacteria were 67.92%（72/106）.Escherichia coli was 16.04%,Enterbacter Cloacae was 16.98%.The bacterial eradication rates and simple treatment Clinical Efficacy Results were no statistically significant difference between the three groups（P〉0.05.In one year follow-up period,fit numbers（patients-1yr-1）were lower in A group than matched group.（158.5±24.7 and B group374.5±46.8,C group 368.4±38.4,P〈0.01）,Time to next exacerbation was longer,98.5±54.4（day） in A groug and 38.2±12.3（day） in B group,43.8±17.2（day） in c group,respectively（P=0.001）.QOL（the disease-specific St.George＇s Respiratory questionnaire（SGRQ）） were lower than treatment before in A group（P〈0.01）.But there were no a significant difference in B and C group（P〉0.05）.After one-year treatment,there was a significant difference in A group and matched（B,C）group（P〈0.01）.After one year,lung function was higher than treatment before in A group（P〈0.01）,there were no a significant difference in matched（B,C）group（P〉0.05）.lung function in A group were significantly higher than�

关 键 词：慢性阻塞性肺疾病 生存质量 肺功能 拜复乐 阿奇霉素 优立新 

分 类 号：R453.2[医药卫生—治疗学]