克拉霉素对慢性阻塞性肺疾病稳定期细胞免疫和肺功能的影响

Effects of clarithromycin on cellular immune and respiratory function in patients with COPD in stable phase

目的探讨克拉霉素在慢性阻塞性肺疾病(COPD)治疗中的作用。方法 108例COPD随机分为两组:A组56例,在基础治疗的基础上加服克拉霉素;B组52例,仅用基础治疗。C组45例,为健康体检者对照组。治疗前及治疗8周后测定血清白细胞介素(IL)-8、IL-6,肿瘤坏死因子(TNF)-α、T淋巴细胞亚群(CD3+,CD4+,CD8+)和CD4+/CD8+比值及FEV1.0和FEV1.0/FVC。结果治疗前,A、B组患者血清IL-8、TNF-α、IL-6、CD8+T淋巴细胞较C组升高,FEV1.0、FEV1.0/FVC较C组下降。克拉霉素治疗后,A组IL-8、TNF-α、IL-6、CD8+T淋巴细胞减低,FEV1.0、FEV1.0/FVC高于治疗前及B组(P<0.01)。IL-8、TNF-α、IL-6、CD8+T淋巴细胞与FEV1.0、FEV1.0/FVC呈负相关,CD4+/CD8+比值与FEV1.0、FEV1.0/FVC呈正相关。结论应用克拉霉素可以降低稳定期COPD患者的IL-8、TNF-α、IL-6的含量,抑制炎症反应,调节细胞免疫功能并能改善肺功能。

Objective To investigate the effects of clarithromycin on cellular immune and respiratory function in patients with COPD in stable phase. Methods A total of 108 patients was randomly assigned to two groups. Group A（56 cases） was treated with basic therapy plus oral clarithromycin,group B（52 cases） with basic therapy alone. Another 45 healthy subjects were taken as blank controls（group C）. Interleukin（IL）-8,IL-6,tumor necrosis factor（TNF）-α,CD3＋,CD4＋,CD8＋ T lymphocytes,CD4＋/CD8＋ ratio in peripheral blood,FEV1.0 and FEV1.0/FVC were measured in three groups before and 8 weeks after treatment.Results Compared with groups of B and C after treatment,group A had significantly lower serum levels of IL-8,TNF-α,IL-6 and CD8＋ T lymphocytes with higher CD4＋/CD8＋ ratio,FEV1.0,and FEV1.0/FVC.Serum levels of IL-8,TNF-α,IL-6 and CD8＋ T lymphocytes were negatively correlated with FEV1.0 and FEV1.0/FVC. CD4＋/CD8＋ ratio was positively correlated to FEV1.0 and FEV1.0/FVC.Conclusion Clarithromycin can reduce serum levels of IL-8,TNF-α and IL-6 in COPD patients in stable phase,inhibit inflammation,regulate cellular immune function and improve lung function.