Division of Infectious Diseases, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto.
Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto.
J Cyst Fibros. 2015 Nov;14(6):755-62. doi: 10.1016/j.jcf.2015.01.007. Epub 2015 Feb 14.
Pulmonary exacerbations are associated with significant lung function decline from baseline in cystic fibrosis (CF) and it is not well understood why some patients do not respond to antibiotic therapy. The objective of this study was to identify factors associated with lung function response to antibiotic treatment of pulmonary exacerbations.
As a secondary analysis of a randomized, controlled trial of intravenous antibiotic treatment for pulmonary exacerbations in CF patients, we investigated whether baseline factors and changes in sputum bacterial density, serum or sputum inflammatory markers were associated with recovery of lung function and risk of subsequent exacerbation.
In 36 of the 70 exacerbations (51%), patients' lung function returned to >100% of their baseline at day 14 of antibiotic treatment; 34 exacerbations were classified as non-responders. Baseline characteristics were not significantly different between responders and non-responders. Less of a drop in FEV1 from baseline to exacerbation (OR 1.09, 95% CI 1.0, 1.18, p=0.04) as well as a greater decrease in sputum neutrophil elastase (OR 2.94, 95% CI 1.07, 8.06, p=0.04) were associated with response to antibiotic treatment at day 14. In addition, higher CRP (HR 1.35 (95% CI: 1.01, 1.78), p=0.04) and sputum neutrophil elastase (HR 1.71 (95% CI: 1.02, 2.88), p=0.04) at day 14 of antibiotic therapy were associated with an increased risk of subsequent exacerbation.
Inadequate reduction of inflammation during an exacerbation is associated with failure to recover lung function and increased risk of subsequent re-exacerbation in CF patients.
在囊性纤维化（CF）中，肺部恶化与从基线开始的肺功能显著下降有关，但尚不清楚为什么有些患者对抗生素治疗没有反应。本研究的目的是确定与抗生素治疗肺部恶化后肺功能恢复相关的因素。
作为 CF 患者静脉内抗生素治疗肺部恶化的随机对照试验的二次分析，我们研究了基线因素以及痰液细菌密度、血清或痰液炎症标志物的变化是否与肺功能恢复和随后恶化的风险相关。
在 70 次恶化中的 36 次（51%），患者的肺功能在抗生素治疗的第 14 天恢复到高于基线的>100%；34 次恶化被归类为无反应者。反应者和无反应者的基线特征无显著差异。从基线到恶化时 FEV1 下降幅度较小（OR 1.09，95%CI 1.0，1.18，p=0.04）以及痰液中性粒细胞弹性蛋白酶下降幅度较大（OR 2.94，95%CI 1.07，8.06，p=0.04）与第 14 天抗生素治疗的反应相关。此外，较高的 CRP（HR 1.35（95%CI：1.01，1.78），p=0.04）和痰液中性粒细胞弹性蛋白酶（HR 1.71（95%CI：1.02，2.88），p=0.04）在抗生素治疗的第 14 天与随后恶化的风险增加相关。
在恶化期间炎症减轻不足与 CF 患者无法恢复肺功能和随后再次恶化的风险增加相关。
