不同维持剂量阿奇霉素长程治疗对稳定期支气管扩张症患者肺功能和生命质量的影响  

The impact of different doses of azithromycin maintenance treatment on expiratory flow limitation and quality of life among stable patients with non-cystic fibrosis bronchiectasis

作　　者：卢刚 陈宇清 丁凤鸣[3] 周新[3] Lu Gang;Chen Yuqing;Ding Fengming;Zhou Xin(Department of Respiratory Medicine, the Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, Chin)

机构地区：[1]上海市博爱医院内科,200031 [2]上海交通大学附属胸科医院呼吸内科,200030 [3]上海交通大学附属第一人民医院呼吸内科

出　　处：《中国医师进修杂志》2018年第6期493-497,共5页Chinese Journal of Postgraduates of Medicine

基　　金：国家自然科学基金（81300005）;上海市卫计委科研项目（20134367）

摘　　要：目的观察不同剂量阿奇霉素维持治疗对预防稳定期非结核性支气管扩张症患者急性加重和对生命质量的影响以及安全性评价。 方法选择伴有慢性化脓性呼吸道症状的稳定期成人支气管扩张症患者132例，利用Excel软件产生的随机序列，随机分为三组，阿奇霉素维持组（40例）口服阿奇霉素片250 mg/次，1次/d，疗程为26周；盐酸氨溴索片30 mg/次，3次/d，疗程26周。阿奇霉素递减组（45例）口服阿奇霉素片250 mg/次，1次/d（8周）- 3次/周（8周）- 2次/周（10周）；盐酸氨溴索片30 mg/次，3次/d，疗程26周。对照组（47例）口服盐酸氨溴索片30 mg/次，3次/d，疗程26周。观察三组患者治疗前后的呼吸道症状、肺功能、FACED评分及下呼吸道感染视觉模拟量表（LRTI-VAS）评分。 结果共有129例患者完成26周的随访。治疗后阿奇霉素维持组和阿奇霉素递减组第一秒用力呼气容积占预计值百分比（FEV1% Pred）[（83.01 ± 5.79）%比（79.39 ± 3.53）%，（84.97 ± 5.10）%比（80.94 ± 3.46）%]较治疗前增高（P〈0.05），两组用力呼气中期流速（FEF25%-75%）在治疗后也有改善[（54.87 ± 5.72）%比（51.86 ± 8.16）%，（55.65 ± 3.39）%比（53.46 ± 5.75）%，P〈0.05]，但治疗后上述指标两组之间比较差异无统计学意义（P〉0.05）。对照组治疗后FEV1% Pred、第一秒用力呼气容积（FEV1）与用力肺活量（FVC）比值、FEF25%-75%水平均下降（P〈0.05），LRTI-VAS评分和FACED评分也轻度降低[（20.55 ± 1.76）分比（21.34 ± 1.86）分，P〈0.05；（4.16 ± 0.75）分比（4.36 ± 0.72）分，P〉0.05]。共有7例患者发生急性加重而住院治疗，其中2例患者退出研究，5例患者在急性加重治疗期间未中断阿奇霉素治疗。共15例患者发生可能与药物相关的不良反应，包括胃部不适、心悸和头痛。 结论对于稳定期支气管扩张症患者，阿奇霉素递减剂Objective To observe the benefits and safety of different maintenance doses of azithromycin for long-term treatment in adult patients with non-cystic fibrosis （CF） bronchiectasis. Methods One hundred and thirty-two indigenous outpatients （〉18 years old） with stable non-CF bronchiectasis were enrolled. All patients were randomly assigned to a control group and two treatment groups. Patients in the azithromycin fixed-dose treatment group received oral azithromycin （250 mg daily） and ambroxol hydrochloride （30 mg, 3 times/d）. Azithromycin progressively decreased dosage treatment group received oral azithromycin （250 mg daily for 8 weeks-250 mg 3 times/week for 8 weeks-250 mg 2 times/week for 10 weeks） and ambroxol hydrochloride （30 mg, 3 times/d）. Subjects in control group only received ambroxol hydrochloride therapy. The course of treatment lasted for 26 weeks. Spirometry, exacerbations, sputum microbiology, quality of life, dyspnea scores and adverse effects were monitored after treatment for 26 weeks. Results One hundred and twenty-nine evaluable subjects completed the study. After treatment, the level of percentage of estimated value forced expiratory volume in 1 second （FEV1% Pred） in azithromycin fixed-dose treatment group and azithromycin progressively decreased dosage treatment group was significantly higher than that before treatment： （83.01 ± 5.79）% vs. （79.39 ± 3.53）%, （84.97 ± 5.10）% vs. （80.94 ± 3.46）%, P 〈 0.05. Forced expiratory flow between 25% and 75% of vital capacity （FEF25%-75%） was also increased in two groups： （54.87± 5.72） % vs. （51.86±8.16）%, （55.65 ± 3.39）% vs. （53.46± 5.75）%, there was significant difference （P 〈 0.05）. But the levels of above parameters between two groups after treatment had no significant differences （P 〉 0.05）. The parameters of FEV1% Pred, forced expiratory volume in 1 second （FEV1）/forced ventilatory capacity （FVC） and FEF25%-75% were lower compared to those before treat

关 键 词：阿奇霉素 支气管扩张症 慢性化脓性肺病 气流受限 

分 类 号：R562.22[医药卫生—呼吸系统]