Cunningham Steven, McColm Janet R, Mallinson Aileen, Boyd Ingrid, Marshall Tom G
Department of Child Life and Health, University of Edinburgh, Edinburgh, UK.
Pediatr Pulmonol. 2003 Jul;36(1):43-8. doi: 10.1002/ppul.10311.
Intravenous (IV) antibiotics are a mainstay of therapy in children with cystic fibrosis. It is unclear, however, over what period associated improvements in pulmonary function are maintained, and to what extent the underlying inflammatory process is impeded in children admitted for a course of IV antibiotics. This was a prospective, interventional study of 14 children (median age, 14 years; interquartile range, 10-14) with cystic fibrosis who were regular sputum producers and who required admission for a 2-week course of IV antibiotics. Children performed spirometry and provided a sputum sample prior to starting IV antibiotics and then weekly for 6 weeks, the first 2 weeks of which IV antibiotics were given. Sputum IL-8, TNF-alpha, IL-6, IL-10, MIP1-alpha, and elastase were measured. Seven children were asked to repeat the protocol in a subsequent exacerbation to assess similarities in response to therapy. Significant improvements were seen in forced expired volume in 1 sec (FEV(1)) in association with IV antibiotics (27% relative improvement in predicted from baseline to end of week 1, median FEV(1) 41.3% increasing to 52.2%), but this continued only 1 week following cessation of antibiotics. Although IL-8 demonstrated a trend for reduction in association with antibiotics, no significant profile was demonstrated for any of the cytokines assessed. IL-10 was detectable in 64% of samples (all <100 pg/ml). In children with two episodes assessed, although there was a close correlation of FEV(1) and FVC between exacerbations (before antibiotics), no significant correlation was seen for IL-8, TNF-alpha, or IL-10 measured in both sets of samples at any sample point (indeed, a discordant response was seen between sample points in the two exacerbations). Although FEV(1) temporarily improves in response to admission for IV antibiotics, no such response is seen in sputum cytokine values. In addition, assessment of cytokines in subsequent exacerbations does not show a similar pattern of response to treatment.
静脉注射抗生素是囊性纤维化患儿治疗的主要手段。然而，目前尚不清楚与肺功能相关的改善能维持多长时间，以及在接受静脉注射抗生素疗程的患儿中，潜在的炎症过程在多大程度上受到抑制。这是一项针对14名囊性纤维化患儿（中位年龄14岁；四分位间距10 - 14岁）的前瞻性干预研究，这些患儿经常咳痰，需要住院接受为期2周的静脉注射抗生素疗程。患儿在开始静脉注射抗生素前进行肺活量测定并提供痰液样本，之后每周进行一次，共6周，其中前2周给予静脉注射抗生素。测定痰液中的白细胞介素 - 8（IL - 8）、肿瘤坏死因子 - α（TNF - α）、白细胞介素 - 6（IL - 6）、白细胞介素 - 10（IL - 10）、巨噬细胞炎性蛋白 - 1α（MIP1 - α）和弹性蛋白酶。7名患儿被要求在随后的病情加重时重复该方案，以评估对治疗反应的相似性。与静脉注射抗生素相关的1秒用力呼气容积（FEV(1)）有显著改善（从基线到第1周结束时预测值相对改善27%，中位FEV(1)从41.3%增至52.2%），但抗生素停用后仅持续1周。尽管IL - 8显示出与抗生素相关的下降趋势，但在所评估的任何细胞因子中均未显示出显著特征。在64%的样本中可检测到IL - 10（均<100 pg/ml）。在接受两次病情评估的患儿中，尽管病情加重（使用抗生素前）时FEV(1)和用力肺活量（FVC）之间密切相关，但在任何样本点，两组样本中测量的IL - 8、TNF - α或IL - 10均无显著相关性（实际上，两次病情加重的样本点之间出现了不一致的反应）。尽管FEV(1)因住院接受静脉注射抗生素而暂时改善，但痰液细胞因子值未见类似反应。此外，在随后病情加重时对细胞因子的评估未显示出类似的治疗反应模式。
