小剂量红霉素治疗减少COPD患者急性加重的作用

Effect of low-dose erythromycin therapy on the prevention of exacerbations in COPD patients

目的评价小剂量红霉素治疗对慢性阻塞性肺疾病（COPD）患者的肺功能及急性加重程度的影响。方法选择100例稳定期COPD患者,随机分为两组（Ⅰ组和Ⅱ组）,每组50例患者。Ⅰ组患者口服红霉素,400 mg/d;Ⅱ组患者口服维生素B2,10 mg/d,治疗1个月后,比较两组COPD患者的肺功能及急性加重程度的影响。结果红霉素组与对照组比较,口服红霉素治疗组患者患感冒次数明显降低（P=0.001）。两组患者年龄、性别、肺功能无明显差异。红霉素组有6例患者（12%）患2次以上感冒,而对照组有37例（75%）。对照组与红霉素组比较,患感冒的相对危险性是9.24（95%可信性区间CI,3.91~31.75,P=0.001）。红霉素组患者急性加重次数比对照组明显减少（P〈0.001）。对照组有26例（52%）出现1次或多次急性加重,红霉素组有5例（10%）经历1次或多次急性加重。对照组与红霉素组比较,急性加重的相对危险性是4.70（95%CI,1.52~14.3,P=0.006）。对照组严重急性加重的患者比红霉素组多（P=0.001）。结论小剂量红霉素治疗能减少COPD患者的急性加重,对肺功能无影响。红霉素治疗不但能预防COPD患者的急性加重,而且能降低COPD急性加重的严重程度。

【Objective】To investigate effect of oral erythromycin on pulmonary function and exacerbations in patients with Chronic Obstructive Pulmonary Disease（COPD）.【Methods】100 patients with COPD were enrolled into the study. Patients were randomly divided into two groups： group Ⅰ and group Ⅱ,each contained 50 patients. The patients in group Ⅰ were treated with erythromycin（200-400 ng/d）, and those in group Ⅱ（control group） received vitamin B2（10mg/d）. After the patients with COPD were treated for four weeks, we observed pulmonary function and the exacerbation in patients with COPD.【Results】The mean number of common colds was significantly lower in the erythromycin group than in the control group（1.2±0.06 VS 4.6±0.02 respectively, per person, P=0.001）. Thirty-seven patients（75%） in the control group had common colds more than once, compared to 6 patients（12%） in the erythromycin group. The relative risk of developing two or more common colds in the control group compared with that in the erythromycin group was 9.24（95% confidence interval CI, 3.91 to 31.75, P=0.001）. Twenty-six patients（52%） in the control group experienced one or more exacerbations, compared to 5 patients（10%） in the erythromycin group. The relative risk of having a exacerbation in the control group compared with that in the erythromycin group was 4.70（95% CI, 1.52 to 14.5, P=0.006）. Significantly more severe exacerbations were observed in the control group than in the erythromycin group（P=0.001）.【Conclusion】Erythromycin theraphy not only prevent exacerbation in COPD patients, but also decrease their severity.