目的 探讨长期小剂量口服罗红霉素对慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)患者炎性反应因子的影响。方法 选取2016-01至2018-05医院收治的慢阻肺患者98例,根据随机数表法分为阿奇霉素组和联合治疗组,每组49例,阿奇霉素组给予口服阿奇霉素0.25 g/次,1次/d,治疗3个月。联合治疗组患者在此基础上给予长期小剂量罗红霉素,口服150 mg/次,1次/d,连续治疗6个月。统计两组治疗后咳嗽缓解和消失时间,临床疗效及并发症发生情况,并比较治疗前后痰量、呼吸困难评分,痰液细胞因子Ⅱ型干扰素(γ-IFN)、白细胞介素-8(IL-8)、肿瘤坏死因子(TNF-α)水平。结果 联合治疗组总有效率(95.91%)明显高于阿奇霉素组(75.51%),差异有统计学意义(P<0.05)。与治疗前相比,两组治疗后痰量、呼吸困难评分、炎性反应因子明显改善,差异有统计学意义(P<0.05)。联合治疗组咳嗽缓解时间和咳嗽消失时间均明显短于阿奇霉素组,差异有统计学意义(P<0.05)。治疗后联合治疗组痰量、呼吸困难评分、γ-IFN、IL-8、TNF-α、呼气峰值流速(PEF)、一秒用力呼气容积(FEV₁)、一秒用力呼气量占所有呼气量比例(FEV₁/FVC)明显优于阿奇霉素组,差异有统计学意义(P<0.05)。结论 长期口服小剂量罗红霉素可减轻慢阻肺患者气道炎性反应,抑制炎性因子水平,改善患者肺功能。

Objective To investigate the effect of long-term low dose roxithromycin on inflammatory factors in patients with chronic obstructive pulmonary disease (COPD). Methods A total of 98 patients with COPD admitted to our hospital between January 2016 and May 2018 were selected and equally divided into the combined group and the azithromycin group using the random number table method. The azithromycin group was treated with intravenous infusion of azithromycin, once a day and for three months, while the combined group was additionally given six-month treatment with roxithromycin. The time of remission and disappearance of cough, clinical efficacy and the occurrence of complications were recorded. The sputum volume, dyspnea scores, sputum cytokines Ⅱ interferon (gamma-IFN), interleukin 8 (IL-8), tumor necrosis factor (TNF alpha) levels were compared between the two groups before and after treatment. Results Cough relief and disappearance took much less time in the combined group than in the azithromycin group (P<0.05). The total effective rate of the combined group (95.91%) was significantly higher than that of the azithromycin group (75.51%) (P<0.05). Before treatment, there was no significant difference in sputum volumes and dyspnea scores between the two groups. After treatment, the sputum volume and dyspnea scores of the two groups were significantly reduced, especially in the combined group (P<0.05). Before treatment, there was no significant difference between the two groups in levels of γ - IFN, IL-8 and TNF-α. After treatment, these levels in the two groups were decreased, especially in the combined group (P<0.05). After treatment, PEF,FEV₁ and FEV₁/FVC in the combined group were improved more significantly than in the azithromycin group. Conclusions Long term roxithromycin can reduce airway inflammation, inhibit the levels of inflammatory factors in sputum and improve the lung function of patients with COPD, which is worthy of clinical popularization.