吸入沙美特罗/氟替卡松联合小剂量红霉素对支气管扩张症患者气道纤毛超微结构和黏液纤毛系统清除功能的影响  

Effect of Inhaled Salmeterol-Fluticasone Combined with Low-Dose Erythromycin on Ciliary Ultrastructure and Mucociliary Clearance of Airway in Patients with Bronchiectasis

作　　者：范慧[1] 徐志伟 胡克[1] 万志辉[1] 陈国忠[1] 胡苏萍[1] 余红樱[1] 

机构地区：[1]武汉大学人民医院呼吸科,湖北武汉4300602 [2]湖北省罗田县万密斋医院,湖北罗田438600

出　　处：《武汉大学学报（医学版）》2013年第2期217-221,共5页Medical Journal of Wuhan University

基　　金：中华医学会临床医学慢性呼吸道疾病科研专项资金资助(编号:09020620217)

摘　　要：目的:观察长期吸入沙美特罗/氟替卡松联合小剂量红霉素对支气管扩张症(简称支扩)患者气道纤毛超微结构和黏液纤毛系统清除功能的影响。方法:支扩患者在经过急性期治疗,病情得到控制后,进行6个月维持治疗(沙美特罗/氟替卡松+口服红霉素)。对6例支扩患者通过纤维支气管镜取支气管黏膜标本进行纤毛超微结构检查,并用放射性气溶胶吸入ECT显像法检测气道黏液纤毛系统清除功能。结果:与对照组相比,支扩患者组纤毛轴丝超微结构异常比例显著升高,前者为(12.3±2.3)%,后者为(21.2±3.3)%,差异有显著性(P<0.001)。同时,支扩患者的肺扫描图像显示右肺中央感兴趣区(C区)及外周感兴趣区(P区)的放射活性清除率(Ct值)均较低,在经沙美特罗/氟替卡松(ICS/β2激动剂)及小剂量红霉素联合治疗6个月后,C区和P区的Ct值均明显提高。结论:支扩患者气道纤毛超微结构受到明显损害,且黏液纤毛系统清除功能下降,而长期吸入ICS/β2激动剂联合小剂量红霉素可在一定程度上改善支扩患者的黏液纤毛系统清除功能。Objective： To evaluate the efficacy of long-term inhaled salmeterol-fluticasone combined with low-dose erythromycin on ciliary ultrastructure and mucociliary clearance （MCC） of airway in pa- tients with bronchiectasis. Methods： After the treatment in acute phase, conditions of the six pa- tients with bronchiectasis involved in this study were under well control, and all the patients were given six months＇maintenance therapy as inhaled salmeterol-fluticasone plus erythromycin. Be- fore and after treatment, bronchial biopsy from bronchoscopy were performed and submitted to 6 patients with bronchiectasis during fiberoptic ultrastructural study of cilia. Meanwhile, MCCin these cases were evaluated by using emisson computed tomography of radioactive particles in- halation technique. Results： Comparing with that in control group, the percentage of axonemal ultrastructure abnormalities（AUA） in patient group was markedly higher as （12.3±2.3）% ver- sus （21.2±3.3） % （P〈0.001）. Clearance rates of 99mTc-DTPA radioactivity at certain times （Ct） in central and peripheral regions were low. Aher 6 months therapy of inhaled salmeterol-fluticasone plus e- rythromycin, clearance rates in both central region and peripheral region increased. Conclusion： In pa- tients with bronchiectasis, ciliary ultrastructure are obviously damaged and the mucociliary clearance of airway are markedly decreased. Long-term inhaled salmeterol-fluticasone combined with low-dose erythromycin may improve the mucociliary clearance to a certain extent.

关 键 词：吸入型糖皮质激素 Β2激动剂 大环内酯类 支气管扩张症 纤毛 黏液纤毛系统清除功能 

分 类 号：R562.2[医药卫生—呼吸系统]