Ilowite Jonathan, Spiegler Peter, Chawla Shalinee
Winthrop University Hospital, State University Hospital of New York at Stony Brook, Stony Brook, NY, USA.
Curr Opin Infect Dis. 2008 Apr;21(2):163-7. doi: 10.1097/QCO.0b013e3282f4f237.
Bronchiectasis is an under-appreciated cause of chronic lung disease in the USA. We highlight developments in diagnosis and treatment of this debilitating disease.
A possible link between gastroesophageal reflux and development of nontuberculous mycobacterial lung disease was highlighted. Reflux is more common in patients with nontuberculous mycobacterial lung disease, and among those with established bronchiectasis more extensive disease was observed in those patients who also had reflux. Long-term mortality in bronchiectasis was significantly associated with age, lower body mass index, dyspnea, lack of vaccination, hypoxemia, hypercapnia, and other functional parameters. In a large, randomized clinical trial, addition of inhaled tobramycin to ciprofloxacin for acute exacerbations of Pseudomonas infection produced microbiologic improvement correlating with clinical outcomes but not overall improvement. A review noted that five macrolide trials reported reduced sputum volume, improved lung function, and better symptom control. Finally, articles suggested benefit from inhaled hyperosmolar agents (e.g. hypertonic saline and inhaled mannitol).
The possible link between gastroesophageal reflux and nontuberculous mycobacterial lung disease, and the microbiology and resistance patterns of bacteria observed in these patients were clarified. A large study of inhaled tobramycin for exacerbations was inconclusive, but macrolide therapy and hyperosmolar agents hold promise.
在美国，支气管扩张是一种未得到充分认识的慢性肺病病因。我们着重介绍了这种使人衰弱的疾病在诊断和治疗方面的进展。
强调了胃食管反流与非结核分枝杆菌肺病发生之间可能存在的联系。胃食管反流在非结核分枝杆菌肺病患者中更为常见，在已确诊支气管扩张的患者中，有胃食管反流的患者病情往往更严重。支气管扩张患者的长期死亡率与年龄、较低的体重指数、呼吸困难、未接种疫苗、低氧血症、高碳酸血症及其他功能参数显著相关。在一项大型随机临床试验中，对于铜绿假单胞菌感染急性加重的患者，在环丙沙星基础上加用吸入用妥布霉素可改善微生物学指标，且与临床疗效相关，但未实现整体改善。一项综述指出，五项大环内酯类药物试验报告称，使用此类药物可减少痰液量、改善肺功能并更好地控制症状。最后，有文章表明吸入高渗剂（如高渗盐水和吸入用甘露醇）有益。
阐明了胃食管反流与非结核分枝杆菌肺病之间可能存在的联系，以及这些患者中观察到的细菌微生物学和耐药模式。一项关于吸入用妥布霉素治疗急性加重期的大型研究尚无定论，但大环内酯类药物治疗和高渗剂有望取得疗效。
