左氧氟沙星对稳定期慢性阻塞性肺疾病中性粒细胞气道炎症的影响研究

Effect of levofloxacin on neutrophilic airway inflammation in stable chronic obstructive pulmonary disease

目的探讨左氧氟沙星对稳定期慢性阻塞性肺疾病中性粒细胞气道炎症的影响。方法利用随机、双盲、安慰剂对照方法,将诊断为慢性阻塞性肺疾病患者28例随机分为两组。分别接受左氧氟沙星500 mg或者安慰剂治疗。连续7 d药物治疗后,在第0（基线）、7、14、28天对患者行痰液诱导用于微分细胞计数和细菌定量分析。结果在基线期,痰液中性粒细胞百分比与气道细菌负载量呈正相关（r=0.66,P=0.002）。对于基线期细菌负载量超过106cfu/ml的病人,7 d治疗后左氧氟沙星组患者减少的中性粒细胞百分比高于安慰剂组26.5%（95%置信区间：1.8%~51.3%）。另外,左氧氟沙星治疗后的中性粒细胞百分比变化与基线气道细菌负载量呈显著负相关（r=-0.78,P=0.003）。结论在稳定期慢性阻塞性肺疾病中,左氧氟沙星可引起气道细菌负载量发生短期的降低,这可能与高细菌负载量患者中性粒细胞气道炎症减少相关。

Objective To investigate the effect of levofloxacin on neutrophilic airway inflammation in stable chronic obstructive pulmonary disease.Methods With a randomized,double-blind,placebo-controlled trial,28 patients diagnosed as chronic obstructive pulmonary disease were chosen in this study,and then were randomized to receive either levofloxacin 500 mg daily or placebo.After the continuous therapy for 7 days,patients underwent sputum induction for a differential cell count and quantitative bacterial analysis at day 0（ baseline）,7,14 and 28.Results At baseline,sputum percentage neutrophil count correlated with airway bacterial load（ r = 0.66,P = 0.002）.In patients with a baseline bacterial load of more than 106 cfu / ml,levofloxacin treatment was associated with a 26.5%（ 95% confidence interval：1.8% -51.3%,P = 0.04） greater reduction in the percentage neutrophil count compared with placebo at day 7.Change in percentage neutrophil count after levofloxacin treatment correlated significantly with baseline airway bacterial load（ r =-0.78,P = 0.003）.Conclusion In stable COPD,levofloxacin treatment causes a short-term reduction in bacterial load,which is associated with a reduction in neutrophilic airway inflammation in patients with high bacterial loads.