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

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。

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

AIM: To investigate the clinical efficacy of azithromycin in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and explore its immunomodulatory role.METHODS: 76 cases of AECOPD patients were enrolled in this study. All the 76 cases were divided 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 analysis.RESULTS: The clinic efficacy in group A and B was 63.2% 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 A and B the IL-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 lower in group B than that in group A (P<0.01), and the TGF-β₁ level 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 patients. The regulation of IL-17/TGF-β₁ balance disorder may play a key role on the mechanism of its significant effect.