Spencer S, Jones P W
Department of Physiological Medicine, St George's Hospital Medical School, London SW17 0RE, UK.
Thorax. 2003 Jul;58(7):589-93. doi: 10.1136/thorax.58.7.589.
The magnitude and time course of effect of an acute exacerbation of chronic bronchitis (AECB) on health status are not known. Data from the GLOBE study, a randomised double blind trial of antibiotic therapy, were used to investigate these effects.
438 patients with AECB received either gemifloxacin 320 mg once daily for 5 days (214 patients) or clarithromycin 500 mg twice daily for 7 days (224 patients) and were followed up for 26 weeks. St George's Respiratory Questionnaire (SGRQ) scores were obtained at baseline and after 4, 12, and 26 weeks.
At presentation during an exacerbation SGRQ scores were worse (Total score difference 5.4 units, 95% CI 1.9 to 8.8, p=0.002) in patients who had a subsequent exacerbation during follow up. The greatest improvement in SGRQ score occurred within the first 4 weeks (mean 8.9 units, 95% CI 6.5 to 11.5, p<0.0001). Subsequently, scores improved more rapidly in patients with no further exacerbations. At 26 weeks the difference between the two groups was 9.6 units (95% CI 5.7 to 13.4, p<0.0001). In patients with no further exacerbations the SGRQ score improved between 4 and 12 weeks by a further 4.1 units (95% CI 2.2 to 5.9, p<0.0001).
A single infective AECB has a sustained effect on health status. The recovery period is long even in patients who have no further exacerbations. A second episode within 6 months limits recovery markedly. Treatments that reduce exacerbation frequency could have a significant impact on health status.
慢性支气管炎急性加重（AECB）对健康状况影响的程度和时间进程尚不清楚。全球慢性阻塞性肺疾病（COPD）纵向研究（GLOBE）的数据，一项抗生素治疗的随机双盲试验，被用于研究这些影响。
438例AECB患者接受每日一次320mg吉米沙星治疗5天（214例患者）或每日两次500mg克拉霉素治疗7天（224例患者），并随访26周。在基线以及4、12和26周后获得圣乔治呼吸问卷（SGRQ）评分。
在随访期间出现再次加重的患者中，加重期就诊时SGRQ评分更差（总分差异5.4分，95%CI 1.9至8.8，p = 0.002）。SGRQ评分的最大改善发生在最初4周内（平均8.9分，95%CI 6.5至11.5，p<0.0001）。随后，无进一步加重的患者评分改善更快。在26周时，两组之间的差异为9.6分（95%CI 5.7至13.4，p<0.0001）。在无进一步加重的患者中，SGRQ评分在4至12周间进一步改善4.1分（95%CI 2.2至5.9，p<0.0001）。
单次感染性AECB对健康状况有持续影响。即使是没有进一步加重的患者，恢复期也很长。6个月内的第二次发作会明显限制恢复。减少加重频率的治疗可能对健康状况有重大影响。
