目的评估长期大环内酯类抗生素治疗非囊性纤维化支气管扩张症的疗效与风险。方法分别检索中国知网、万方数据、中国生物医学网、维普网、PubMed、Embase、Cochrane Library及Web of Science数据库中已发表的关于长期大环内酯类抗生素治...目的评估长期大环内酯类抗生素治疗非囊性纤维化支气管扩张症的疗效与风险。方法分别检索中国知网、万方数据、中国生物医学网、维普网、PubMed、Embase、Cochrane Library及Web of Science数据库中已发表的关于长期大环内酯类抗生素治疗非囊性纤维化支气管扩张症疗效与风险的随机对照研究。主要结局指标为急性发作频率、24 h痰量改变、炎症指标改变、菌群分布变化与菌群耐药变化。结果共纳入11项随机对照试验,长期大环内酯类抗生素治疗显著降低非囊性纤维化支气管扩张症的急性加重频率,包括至少发生一次急性加重人数(RR=0.63,95%CI:0.46~0.86,P=0.004)和人均急性加重次数(MD=-1.29,95%CI:-1.72~-0.86,P<0.00001)以及降低24 h痰量(MD=-8.10,95%CI:-12.62~-3.58,P=0.0004)。亚组分析显示,3个月以上大环内酯类抗生素治疗可有效降低成年患者急性加重频率。在3个月以下疗程亚组、红霉素治疗亚组以及儿童患者亚组中,大环内酯类抗生素未显著降低急性加重频率。患者种族差异未对治疗效果产生明显影响。基线水平常见痰菌种类及数量、治疗结束后的痰菌种类及数量、治疗结束后痰菌的增加和清除率指标在大环内酯类抗生素治疗组和对照组之间的差异均无统计学意义,但大环内酯类抗生素治疗组的痰菌耐药率显著增加。结论3个月以上大环内酯类抗生素治疗可以显著降低成人非囊性纤维化支气管扩张症患者的急性加重频率,减少24 h痰量。长期大环内酯类抗生素治疗对非囊性纤维化支气管扩张症患者痰菌分布及变化无显著影响,但有提高耐大环内酯类抗生素细菌比例的风险。展开更多
Background Obstructive sleep apnea syndrome （OSAS） is an important risk factor for cardiovascular diseases. Chronic intermittent hypoxia （CIH） is considered to be one of the most important causes of cardiovascular...Background Obstructive sleep apnea syndrome （OSAS） is an important risk factor for cardiovascular diseases. Chronic intermittent hypoxia （CIH） is considered to be one of the most important causes of cardiovascular diseases in OSA patients. This repeated hypoxia and reoxygenation cycle is similar to hypoxia-reperfusion injury, which initiates oxidative stress. In this study, we observed cardiocytes injury induced by CIH and the effect of N-acetylcysteine （NAC）. Methods Thirty ICR mice were randomly assigned to 3 groups： control, CIH and NAC （CIH＋NAC） groups. Malondialdehyde （MDA） and superoxide dismutase （SOD） of cardiocyte homogenates were measured. Serum lipids were measured by an instrument method. Serum cardiac troponin I （cTnl） was detected by enzyme-linked immunosorbent assays （ELISA）. Myocardium pathological sections were observed. Results （1） The SOD activity and MDA concentration of cardiocyte homogenates in the CIH group were significantly higher than in other groups （P 〈0.005）. The MDA concentration of the NAC group was lower than that of the control group （P 〈0.01）. （2） The serum cTnl concentration of the CIH and NAC groups was significantly higher than that of the control group （P 〈0.01）. （3） Serum triglyceride levels in the NAC group were lower than in the other groups （P 〈0.01）, while there were no significant differences in low density lipoprotein and high density lipoprotein among the three groups. （4） The degeneration of myocardium, transverse striation blurred, and fabric effusion were observed in tissue sections in the CIH and NAC groups. However, normal tissue was found in the control group. Conclusion The oxidative stress induced by CIH can injure cardiocytes and the injury effect can be partially inhibited by NAC.展开更多
基金This study was supported by the grants from National Natural Science Foundation of China （No. 30770954） and the Nanjing Technology Plan Projects （No. 20080253） and Jiangsu Province College Students Practical Innovative Training Plan Projects （No. 2007012）.
文摘Background Obstructive sleep apnea syndrome （OSAS） is an important risk factor for cardiovascular diseases. Chronic intermittent hypoxia （CIH） is considered to be one of the most important causes of cardiovascular diseases in OSA patients. This repeated hypoxia and reoxygenation cycle is similar to hypoxia-reperfusion injury, which initiates oxidative stress. In this study, we observed cardiocytes injury induced by CIH and the effect of N-acetylcysteine （NAC）. Methods Thirty ICR mice were randomly assigned to 3 groups： control, CIH and NAC （CIH＋NAC） groups. Malondialdehyde （MDA） and superoxide dismutase （SOD） of cardiocyte homogenates were measured. Serum lipids were measured by an instrument method. Serum cardiac troponin I （cTnl） was detected by enzyme-linked immunosorbent assays （ELISA）. Myocardium pathological sections were observed. Results （1） The SOD activity and MDA concentration of cardiocyte homogenates in the CIH group were significantly higher than in other groups （P 〈0.005）. The MDA concentration of the NAC group was lower than that of the control group （P 〈0.01）. （2） The serum cTnl concentration of the CIH and NAC groups was significantly higher than that of the control group （P 〈0.01）. （3） Serum triglyceride levels in the NAC group were lower than in the other groups （P 〈0.01）, while there were no significant differences in low density lipoprotein and high density lipoprotein among the three groups. （4） The degeneration of myocardium, transverse striation blurred, and fabric effusion were observed in tissue sections in the CIH and NAC groups. However, normal tissue was found in the control group. Conclusion The oxidative stress induced by CIH can injure cardiocytes and the injury effect can be partially inhibited by NAC.
