Thornton J, Elliott R, Tully M P, Dodd M, Webb A K
School of Pharmacy and Pharmaceutical Sciences, University of Manchester M13 9PL, UK.
Thorax. 2004 Mar;59(3):242-6. doi: 10.1136/thx.2003.005876.
Several studies have suggested that clinical outcomes in adults with cystic fibrosis (CF) are equivalent after home and hospital treatment with intravenous antibiotics, but these studies were small and selective and only considered one course of treatment.
A retrospective longitudinal study was performed to compare the clinical outcome over a period of 1 year of all patients attending the Manchester Adult CF Unit who received intravenous antibiotics at home or in hospital. The primary outcome measure was percentage change in forced expiratory volume in 1 second (FEV(1)) at the end of the 1 year period. Baseline "best" and "average" FEV(1) values were established for each patient for the year before the study. The secondary outcome measures were percentage changes in forced vital capacity (FVC) and body weight.
A total of 116 patients received 454 courses of intravenous antibiotics. At the end of 1 year there had been a mean percentage decline in FEV(1) compared with the baseline "average" for patients treated mostly at home but an improvement in patients treated mostly in hospital (Tukey's HSD mean difference 10.1%, 95% CI 2.9 to 17.2, p = 0.003). For all patients there was a mean percentage decline in FEV(1) from the baseline "best" value. For each course of treatment the mean percentage improvements in FEV(1) at the end of the course from the start of the course were significantly higher for patients treated in hospital than for those treated at home.
Clinical outcome, as defined by spirometric parameters and body weight, was better after a course of treatment in hospital than after home treatment, and this benefit was maintained over 1 year of treatment. The results suggest that patients treated at home need closer supervision.
多项研究表明，成年囊性纤维化（CF）患者在家中与在医院接受静脉抗生素治疗后的临床结局相当，但这些研究规模较小且具有选择性，仅考虑了一个疗程的治疗。
进行了一项回顾性纵向研究，以比较曼彻斯特成人CF病房所有接受家庭或医院静脉抗生素治疗的患者在1年期间的临床结局。主要结局指标是1年期末1秒用力呼气量（FEV₁）的百分比变化。为每位患者确定了研究前一年的基线“最佳”和“平均”FEV₁值。次要结局指标是用力肺活量（FVC）和体重的百分比变化。
共有116例患者接受了454个疗程的静脉抗生素治疗。1年末，与主要在家治疗的患者的基线“平均”值相比，FEV₁平均百分比下降，但主要在医院治疗的患者有所改善（Tukey's HSD平均差异10.1%，95%CI 2.9至17.2，p = 0.003）。对于所有患者，FEV₁较基线“最佳”值均有平均百分比下降。对于每个疗程，在疗程结束时与开始时相比，医院治疗的患者FEV₁的平均百分比改善明显高于在家治疗的患者。
根据肺量计参数和体重定义的临床结局，在医院进行一个疗程治疗后比在家治疗更好，且这种益处持续了1年的治疗时间。结果表明，在家治疗的患者需要更密切的监测。
