Lyon A J, McColm J, Middlemist L, Fergusson S, McIntosh N, Ross P W
Neonatal Unit, Simpson Memorial, Maternity Pavilion, Edinburgh.
Arch Dis Child Fetal Neonatal Ed. 1998 Jan;78(1):F10-4. doi: 10.1136/fn.78.1.f10.
To determine if erythromycin given from birth reduces the inflammatory response and the incidence and severity of chronic lung disease.
Seventy five infants less than 30 weeks of gestation and ventilated from birth for lung disease were randomly assigned to receive erythromycin intravenously for 7 days or to no treatment. Ureaplasma urealyticum was detected in tracheal secretions by culture and polymerase chain reaction. Differential cell counts were obtained from bronchoalveolar lavage fluid collected daily for 5 days and concentrations of the cytokines interleukins IL-1 beta and IL-8, and tumour necrosis factor alpha (TNF-alpha) were measured. Chronic lung disease (CLD) was defined as oxygen dependency at 36 weeks of gestation.
Nine infants (13%) were positive for U urealyticum. The inflammatory cytokines in the lungs increased over the first 5 days of life in all babies, but no association was found between their concentrations and the development of CLD. Those treated with erythromycin showed no significant differences from the non-treated group in the differential cell counts or concentrations of the cytokines. The two groups had a similar incidence of CLD. Babies infected with U urealyticum did not have a more pronounced cytokine response than those without infection. Chorioamnionitis was associated with significantly higher concentrations of IL-1 beta and IL-8 on admission: these babies had less severe acute lung disease and developed significantly less CLD.
U urealyticum in the trachea was not associated with an increased inflammatory response in preterm infants. Erythromycin did not reduce the incidence or severity of CLD.
确定出生后即给予红霉素是否能减轻炎症反应以及降低慢性肺病的发生率和严重程度。
75名胎龄小于30周且因肺病自出生起即接受机械通气的婴儿被随机分为两组，一组静脉注射红霉素7天，另一组不接受治疗。通过培养和聚合酶链反应检测气管分泌物中的解脲脲原体。连续5天每天采集支气管肺泡灌洗液进行细胞分类计数，并检测细胞因子白细胞介素IL-1β、IL-8和肿瘤坏死因子α（TNF-α）的浓度。慢性肺病（CLD）定义为孕36周时仍需吸氧。
9名婴儿（13%）解脲脲原体检测呈阳性。所有婴儿肺部的炎症细胞因子在出生后的前5天均有所增加，但未发现其浓度与CLD的发生之间存在关联。接受红霉素治疗的婴儿与未治疗组在细胞分类计数或细胞因子浓度方面无显著差异。两组CLD的发生率相似。感染解脲脲原体的婴儿与未感染的婴儿相比，细胞因子反应并未更明显。绒毛膜羊膜炎与入院时IL-1β和IL-8的浓度显著升高相关：这些婴儿的急性肺病较轻，CLD的发生率也显著较低。
气管中的解脲脲原体与早产儿炎症反应增加无关。红霉素并未降低CLD的发生率或严重程度。
