阿奇霉素对非铜绿假单胞菌感染囊性纤维化患者系统炎症标志物的影响。
Effect of azithromycin on systemic markers of inflammation in patients with cystic fibrosis uninfected with Pseudomonas aeruginosa.
机构信息
Division of Respiratory Medicine, Department of Pediatrics, and Program in Physiology and Experimental Medicine, SickKids Research Institute, The Hospital for Sick Children, and University of Toronto, Toronto, ON, Canada.
Department of Pediatrics, Columbia University, New York, NY.
出版信息
Chest. 2012 Nov;142(5):1259-1266. doi: 10.1378/chest.12-0628.
BACKGROUND
While the mechanism of action by which azithromycin exerts positive effects inpatients with cystic fibrosis remains unclear, evidence suggests that azithromycin may act as an immunomodulatory agent. We examined changes in systemic inflammatory markers in a doubleblind, randomized, controlled trial of oral azithromycin in patients 6-18 years of age with cystic fibrosis who were uninfected with Pseudomonas aeruginosa.
METHODS
WBC counts and differential, serum myeloperoxidase (MPO), high-sensitivity C reactive protein (hsCRP), intracellular adhesion molecule 1, IL-6, calprotectin, serum amyloid A (SAA),and granulocyte colony-stimulating factor (G-CSF) were measured at baseline and after 28 and 168 days of treatment in patients receiving either oral azithromycin or placebo.
RESULTS
Inflammatory markers were similar in both groups at baseline. HsCRP, MPO, SAA, calprotectin,and the absolute neutrophil count (ANC) significantly decreased from baseline today 28 in the azithromycin group compared with the placebo group ( P < .05). This treatment effect was sustained at day 168 for ANC, calprotectin, and SAA ( P < .05). Changes in hsCRP, calprotectin,and SAA at day 28 were negatively correlated with changes in FEV 1 (L) and FEV 1(% predicted), as well as both absolute and relative changes in weight ( P < .05). Except for weight (%),the associations remained significant for calprotectin; FEV 1 (L) and weight (%) remained significantly correlated with the 168-day change in hsCRP. The 168-day change in ANC was significantly correlated with changes in lung function, but not in weight; the change in G-CSF was significantly correlated with the change in weight (%) only.
CONCLUSIONS
In patients not infected with P aeruginosa , oral azithromycin significantly reduced neutrophil counts and serum inflammatory markers within 28 days of initiating treatment.
TRIAL REGISTRY
ClinicalTrials.gov; No.: NCT00431964; URL: www.clinicaltrials.gov
背景
虽然阿奇霉素对囊性纤维化患者产生积极影响的作用机制尚不清楚，但有证据表明，阿奇霉素可能作为一种免疫调节剂。我们在一项针对未感染铜绿假单胞菌的 6-18 岁囊性纤维化患者的口服阿奇霉素双盲、随机、对照试验中，研究了系统炎症标志物的变化。
方法
在接受阿奇霉素或安慰剂治疗的患者中，分别在基线、28 天和 168 天测量白细胞计数和分类、血清髓过氧化物酶（MPO）、高敏 C 反应蛋白（hsCRP）、细胞间黏附分子 1、IL-6、钙卫蛋白、血清淀粉样蛋白 A（SAA）和粒细胞集落刺激因子（G-CSF）。
结果
两组患者在基线时的炎症标志物相似。与安慰剂组相比，阿奇霉素组 hsCRP、MPO、SAA、钙卫蛋白和绝对中性粒细胞计数（ANC）从基线开始在第 28 天显著下降（P<0.05）。这种治疗效果在 ANC、钙卫蛋白和 SAA 的第 168 天持续存在（P<0.05）。第 28 天 hsCRP、钙卫蛋白和 SAA 的变化与 FEV1（L）和 FEV1（%预计值）以及体重的绝对和相对变化呈负相关（P<0.05）。除体重（%）外，钙卫蛋白的相关性仍有统计学意义；FEV1（L）和体重（%）与 hsCRP 的 168 天变化仍显著相关。ANC 的 168 天变化与肺功能变化显著相关，但与体重无关；G-CSF 的变化仅与体重（%）的变化显著相关。
结论
在未感染铜绿假单胞菌的患者中，口服阿奇霉素在开始治疗后 28 天内显著降低中性粒细胞计数和血清炎症标志物。
试验注册
ClinicalTrials.gov；编号：NCT00431964；网址：www.clinicaltrials.gov
Zotero 插件