阿奇霉素对慢性阻塞性肺疾病急性加重患者的免疫调节作用研究

The immunomodulatory role of azithromycin in acute exacerbations of chronic obstructive pulmonary disease

目的:观察阿奇霉素对慢性阻塞性肺疾病急性加重期(AECOPD)患者的临床疗效,并探讨其对患者免疫功能的调节作用。方法:收集本院呼吸内科2010年6月-2012年6月诊治的AECOPD患者76例,随机分成2组:常规治疗对照组(A,n=38)和阿奇霉素治疗组(B,n=38)。另取本院体检中心健康体检者作为正常对照组(C,n=30)。比较两组的临床疗效和不良反应。ELISA法测定IL-17和转化生长因子-β1(TGF-β1)的表达。结果:A组和B组的临床治疗有效率分别为63.2%和84.2%,B组的临床疗效显著优于A组(P<0.05)。A和B组治疗前IL-17和TGF-β1表达水平与C组之间存在统计学差异(P<0.01),治疗后A和B组IL-17表达水平较治疗前显著减低(P<0.05),TGF-β1表达水平则显著升高(P<0.05),但B组治疗后IL-17表达水平显著低于A组治疗后的表达水平(P<0.01),TGF-β1表达水平则显著高于A组治疗后的表达水平(P<0.05)。A组和B组的不良反应发生率分别为7.9%和10.5%,两组之间无统计学差异(P>0.05)。结论:阿奇霉素治疗AECOPD临床疗效显著,调节IL-17/TGF-β1平衡紊乱可能是其疗效显著的主要作用机制。

AIM. To investigate the clinical efficacy of azithromycin in acute exacerbations of chronic obstructive pulmonary disease （AECO- PD） and explore its immunomodulatory role. METHODS： 76 cases of AECOPD patients were enrolled in this study. All the 76 cases were di vided into two groups： control treatment group （A, n： 38） and azithromycin treatment group （B, n：38）. Another 30 healthy person were used as normal control group （C, n：30）. The clinic efficacy and effects of drugs was compared between the two groups. The serum levels of IL-17 and TGF-β1 was measured with ELISA a nalysis. RESULTS：The clinic efficacy in group A and B was 63.9,% and 84.2%, respectively, which was higher in group B than in group A （P 〈0.05）. The serum levels of IL-17 and TGF-β1 in group A and B were significantly different as compared with group C at pretreatment （P〈 0.05）. Compared with pretreatment, in group Aand B the 1L-17 level was significantly decreased （P〈0.05）, and TGF-β1 level was significantly increased （P〈0.05） at post-treatment. At post treatment, the IL-17 level was significantly low er in group B than that in group A （P〈0.01）, and the TGF-β1level was significantly higher in group B than that in group A （P〈0.05）. The incidence of side effects in group A and B were 7.9% and 10.5%, respectively. There was no significant difference between the two groups （P 〈0.05）. CONCLUSION. Azithromycin showed more effectively clinical efficacy on AECOPD pa tients. The regulation of IL-17/TGF-β1balance disorder may play a key role on the mechanism of its significant effect.