Hill S L, Burnett D, Hewetson K A, Stockley R A
Lung Immunobiochemical Research Laboratory, General Hospital, Birmingham.
Q J Med. 1988 Feb;66(250):163-73.
Continuous treatment with antibiotics for 16 weeks was given to 10 patients with bronchiectasis who regularly produced purulent elastase positive secretions. Macroscopic clearance of secretions (from purulent to mucoid or mucopurulent) was achieved in all patients, and this was associated with a significant reduction in the average sputum elastase content by week 16 (p less than 0.001) when elastase was only detectable in three of the patients. Lung inflammation was also reduced as reflected in the sputum to serum albumin ratios. In addition patients noted a significant improvement in well being, and breathlessness as well as in sputum colour and volume and there was a significant improvement in peak expiratory flow. After cessation of treatment the time taken for the sputum to become purulent again ranged from 15 days to 10 months (median 2.5 months), which is longer than that seen previously following short courses of antibiotic treatment. Serum levels of the acute phase protein alpha 1 antichymotrypsin fell by week 16, although this failed to reach statistical significance. However, in eight patients where data were available the levels rose significantly after treatment had finished. The concentrations were consistently higher than those seen in healthy controls, and were also elevated in less severely affected patients suggesting that bronchiectasis is always associated with some systemic effect.
对10例支气管扩张症患者进行了为期16周的抗生素持续治疗，这些患者经常咳出脓性且弹性蛋白酶呈阳性的分泌物。所有患者的分泌物均实现了肉眼可见的清除（从脓性变为黏液性或黏液脓性），并且到第16周时，平均痰液弹性蛋白酶含量显著降低（p<0.001），此时仅在3例患者中可检测到弹性蛋白酶。痰液与血清白蛋白比值也反映出肺部炎症有所减轻。此外，患者表示健康状况、呼吸困难以及痰液颜色和量均有显著改善，呼气峰值流速也有显著提高。治疗停止后，痰液再次变为脓性所需的时间为15天至10个月（中位数为2.5个月），这比之前短期抗生素治疗后的时间要长。急性期蛋白α1抗糜蛋白酶的血清水平到第16周时有所下降，尽管未达到统计学显著性。然而，在有数据的8例患者中，治疗结束后其水平显著升高。这些浓度始终高于健康对照组，且在病情较轻的患者中也有所升高，这表明支气管扩张症总是伴有一些全身影响。
