红霉素治疗对慢性铜绿假单胞菌感染患者的长期影响。
Long term effect of erythromycin therapy in patients with chronic Pseudomonas aeruginosa infection.
作者信息
Fujii T, Kadota J, Kawakami K, Iida K, Shirai R, Kaseda M, Kawamoto S, Kohno S
机构信息
Second Department of Internal Medicine, Nagasaki University School of Medicine, Japan.
出版信息
Thorax. 1995 Dec;50(12):1246-52. doi: 10.1136/thx.50.12.1246.
BACKGROUND
Diffuse panbronchiolitis is a chronic infection of the lower respiratory tract common among the Japanese people, with a persistent Pseudomonas aeruginosa infection in the late stage and sustained neutrophil retention in the airways. The long term effect of erythromycin was examined retrospectively in a group of patients with diffuse panbronchiolitis, with and without P aeruginosa infection, and the relationship between drug-induced bacterial clearance and clinical improvement was investigated.
METHODS
The history, daily volume of sputum, type of organisms in sputum cultures, pulmonary function tests, arterial blood gas tensions, and chest radiographs were compared in 16 patients with diffuse panbronchiolitis with P aeruginosa infection and 12 without. The total and differential cell counts in the bronchoalveolar lavage (BAL) fluid were compared in 14 of the 28 patients (five of whom were infected with P aeruginosa) before and after 1-12 months of treatment with erythromycin (600 mg/day). The outcome of treatment in patients showing clearance of organisms on repeated sputum cultures was compared with that in those demonstrating persistence of bacteria in the sputum and patients with normal flora.
RESULTS
Erythromycin improved respiratory function and arterial blood gas tensions irrespective of the presence or absence of P aeruginosa in the sputum. Treatment also resulted in a reduction in the BAL fluid total cell count and the percentage of neutrophils in both groups of patients. There were no differences between patients in whom the bacteria cleared and those with persistent bacteria or patients with a normal flora with regard to the degree of improvement of respiratory function, arterial blood gas tensions, and BAL fluid cell composition.
CONCLUSION
The results suggest that the efficacy of erythromycin in diffuse pan-bronchiolitis may be due to anti-inflammatory effect, independent of P aeruginosa infection or bacterial clearance.
背景
弥漫性泛细支气管炎是一种常见于日本人的下呼吸道慢性感染性疾病，晚期存在铜绿假单胞菌持续感染，气道中有持续的中性粒细胞潴留。回顾性研究了红霉素对一组弥漫性泛细支气管炎患者（有无铜绿假单胞菌感染）的长期影响，并研究了药物诱导的细菌清除与临床改善之间的关系。
方法
比较了16例有铜绿假单胞菌感染的弥漫性泛细支气管炎患者和12例无该菌感染患者的病史、每日痰量、痰培养中的微生物类型、肺功能测试、动脉血气张力和胸部X线片。在28例患者中的14例（其中5例感染铜绿假单胞菌）接受红霉素（600mg/天）治疗1 - 12个月前后，比较支气管肺泡灌洗（BAL）液中的总细胞计数和分类细胞计数。比较反复痰培养显示细菌清除的患者、痰中细菌持续存在的患者以及正常菌群患者的治疗结果。
结果
无论痰中有无铜绿假单胞菌，红霉素均可改善呼吸功能和动脉血气张力。治疗还使两组患者的BAL液总细胞计数和中性粒细胞百分比降低。在呼吸功能改善程度、动脉血气张力和BAL液细胞组成方面，细菌清除的患者与细菌持续存在的患者或正常菌群患者之间无差异。
结论
结果表明，红霉素在弥漫性泛细支气管炎中的疗效可能归因于抗炎作用，与铜绿假单胞菌感染或细菌清除无关。
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