Klinik für Pneumologie, Medizinische Hochschule Hannover.
Dtsch Arztebl Int. 2011 Dec;108(48):809-15. doi: 10.3238/arztebl.2011.0809. Epub 2011 Dec 2.
Radiologically evident bronchiectasis is seen in 30% to 50% of patients with advanced chronic obstructive pulmonary disease (COPD). As COPD is now becoming more common around the world, bronchiectasis is as well.
We review pertinent articles published before May 2011 that were retrieved by a selective PubMed search.
The principles of treatment of bronchiectasis in patients who do not have cystic fibrosis ("non-CF bronchiectasis") are derived from the treatment of other diseases: secretolytic and anti-infectious treatment are given as in cystic fibrosis, while anti-obstructive treatment is given as in COPD. The few randomized trials of treatment for non-CF bronchiectasis that have been completed to date do not permit the formulation of any evidence-based recommendations. Many potential treatments are now under evaluation. Hypertonic saline is often used because of its demonstrated benefit in CF, even though no benefit has yet been shown for non-CF bronchiectasis. Phase II trials of inhaled mannitol have yielded promising results, leading to phase III trials that are now underway. There may be a future role for inhaled antibiotics, particularly in patients colonized with Gram-negative pathogens. Inhaled tobramycin and colistin are well established in clinical practice, though not approved for non-CF bronchiectasis; clinical trials of aztreonam, ciprofloxacin, and gentamicin are ongoing. Macrolides seem to bring an additional benefit, though the studies that documented this involved only small numbers of patients. Long-term treatment with inhaled antibiotics and/or macrolides is indicated only if a benefit is seen within three months of the start of treatment (less sputum, no exacerbations).
A national registry of patients with bronchiectasis should be established to help us gain better knowledge of its prognostic factors and treatment options.
放射学上明显的支气管扩张可见于 30%至 50%的晚期慢性阻塞性肺疾病（COPD）患者中。由于 COPD 在世界范围内变得越来越普遍，支气管扩张也是如此。
我们回顾了 2011 年 5 月之前发表的相关文章，这些文章是通过选择性的 PubMed 搜索检索到的。
对于没有囊性纤维化（“非 CF 支气管扩张”）的患者，支气管扩张的治疗原则是从囊性纤维化的治疗中得出的：与囊性纤维化一样，给予化痰和抗感染治疗，与 COPD 一样，给予抗阻塞治疗。迄今为止，已经完成的针对非 CF 支气管扩张的少数随机治疗试验，尚不能提出任何循证建议。目前正在评估许多潜在的治疗方法。高渗盐水经常被使用，因为它在 CF 中的疗效已得到证实，尽管对非 CF 支气管扩张症尚未显示出益处。吸入甘露醇的 II 期临床试验取得了有希望的结果，导致目前正在进行的 III 期临床试验。吸入抗生素可能具有未来的作用，特别是在革兰氏阴性病原体定植的患者中。吸入妥布霉素和粘菌素在临床实践中得到了很好的应用，尽管它们尚未获得非 CF 支气管扩张症的批准；正在进行氨曲南、环丙沙星和庆大霉素的临床试验。大环内酯类似乎带来了额外的益处，尽管记录这一点的研究仅涉及少数患者。如果在开始治疗的三个月内（痰量减少，无恶化）观察到治疗效果，则应长期使用吸入抗生素和/或大环内酯类药物。
应建立一个支气管扩张患者的国家登记处，以帮助我们更好地了解其预后因素和治疗选择。
