Terpstra Lotte C, Altenburg Josje, Mohamed Hoesein Firdaus A, Bronsveld Inez, Go Shirley, van Rijn Philip A C, De Jong Pim A, Heijerman Harry G M, Boersma Wim G
Department of Pulmonary Diseases, Northwest Clinics, Alkmaar, the Netherlands.
Department of Pulmonary Diseases, Academic Medical Center, Amsterdam, the Netherlands.
Respir Med. 2022 Feb;192:106718. doi: 10.1016/j.rmed.2021.106718. Epub 2021 Dec 28.
Bronchiectasis (abnormal dilatation of bronchi) is usually diagnosed by high resolution computed tomography (HRCT) and radiological severity has been found to correspond with clinical outcome. A beneficial effect of macrolides maintenance treatment in frequent exacerbating bronchiectasis patients has been established in randomized trials. This study was undertaken to prospectively evaluate the effect of long-term azithromycin (AZM) on radiological features in patients with bronchiectasis.
The BAT randomized controlled trial (2008-2010) investigated the effect of 1 year of AZM (250 mg OD) in bronchiectasis with frequent exacerbations. Chest (HR)CT-scans at baseline and after one year of study treatment were obtained and scored by two radiologists according to the Brody - and the Bhalla scoring system.
77 (93%) patients conducted the BAT trial were evaluated in this post-hoc analysis. A significant improvement of the radiological features based on the Brody score was found after one year of AZM therapy as compared to placebo (p = 0.024), with a not significant improvement of the Bhalla score (p=0.071). Especially the consolidation (Bhalla) and parenchymal changes (Brody) sub scores significantly improved (both p=0.030), and even a radiological deterioration was seen on the Brody bronchiectasis sub score for the placebo treated patients (mean 14.5 (11.7) vs.15.7 (11.9)).
The beneficial effect of long-term AZM treatment on radiological features was demonstrated in this randomized controlled trial. (HR)CT's can be used as an objective measure of treatment response in bronchiectasis.
NCT00415350.
支气管扩张（支气管异常扩张）通常通过高分辨率计算机断层扫描（HRCT）诊断，并且已发现放射学严重程度与临床结果相关。在随机试验中已证实大环内酯类维持治疗对频繁加重的支气管扩张患者有有益作用。本研究旨在前瞻性评估长期阿奇霉素（AZM）对支气管扩张患者放射学特征的影响。
BAT随机对照试验（2008 - 2010年）研究了1年AZM（250毫克每日一次）对频繁加重的支气管扩张的影响。在基线和研究治疗1年后获得胸部（HR）CT扫描，并由两名放射科医生根据Brody评分系统和Bhalla评分系统进行评分。
在这项事后分析中评估了77名（93%）参与BAT试验的患者。与安慰剂相比，AZM治疗1年后基于Brody评分的放射学特征有显著改善（p = 0.024），而Bhalla评分改善不显著（p = 0.071）。特别是实变（Bhalla）和实质改变（Brody）子评分显著改善（均为p = 0.030），甚至在安慰剂治疗患者的Brody支气管扩张子评分上出现了放射学恶化（平均值14.5（11.7）对15.7（11.9））。
在这项随机对照试验中证明了长期AZM治疗对放射学特征的有益作用。（HR）CT可作为支气管扩张治疗反应的客观测量指标。
NCT00415350。
