Kudoh S, Azuma A, Yamamoto M, Izumi T, Ando M
Fourth Department of Internal Medicine, Nippon Medical School, Tokyo.
Am J Respir Crit Care Med. 1998 Jun;157(6 Pt 1):1829-32. doi: 10.1164/ajrccm.157.6.9710075.
Diffuse panbronchiolitis (DPB) is a chronic inflammatory disease of the airways with a high rate of mortality despite treatment with a combination of antibiotics and the use of supportive therapy such as oxygen administration. Low-dose erythromycin therapy (EM) (400 to 600 mg/d) has been found to improve the survival of patients with DPB, and most patients with DPB in Japan have been treated with this erythromycin regime since 1984. The purpose of this study was to evaluate the effects of treatment with erythromycin on the survival rate of patients with DPB in Japan. We compared the survival rates of 498 patients with DPB after dividing them into three groups according to the date of their first medical examination (Group a: 1970-1979, Group b: 1980-1984, Group c: 1985-1990). DPB had been diagnosed in these patients using the criteria of the Ministry of the Health and Welfare Diffuse Lung Disease Committee (MHW-DLDC), which includes chronic productive cough, shortness of breath, presence of roentgenologically smoldering symmetrical granular shadows in the middle and lower lung fields, limitation of airflow without decrease in DLCO, elevated serum cold hemagglutinin titers, and/or narrowing bronchiolus with infiltration of lymphocytes and foamy alveolar macrophages. These patients were registered in the DPB research group of the Ministry of Health and Welfare (MHW). Survival rates were statistically compared using the generalized-Wilcoxon test. The survival rate of Group c was significantly higher than that of Groups a (p < 0.0001) and b (p < 0. 0001). In Group c, eight of 87 patients died; five died in the EM nontreated subgroup (n = 24), and three died in the EM-treated subgroup (n = 63). There was a significant difference in the survival rates between the two subgroups in Group c (p < 0.001). Treatment with EM was associated with a significant improvement in the rate of survival of patients with DPB. The efficacy of EM treatment increased the survival rate of patients with DPB, which was more significant in the older than in the younger patients.
弥漫性泛细支气管炎（DPB）是一种气道慢性炎症性疾病，尽管采用抗生素联合吸氧等支持性治疗，其死亡率仍很高。低剂量红霉素疗法（EM）（400至600毫克/天）已被发现可提高DPB患者的生存率，自1984年以来，日本大多数DPB患者都接受了这种红霉素治疗方案。本研究的目的是评估红霉素治疗对日本DPB患者生存率的影响。我们将498例DPB患者按首次体检日期分为三组（A组：1970 - 1979年，B组：1980 - 1984年，C组：1985 - 1990年），比较了他们的生存率。这些患者根据厚生省弥漫性肺病委员会（MHW - DLDC）的标准被诊断为DPB，该标准包括慢性咳痰、气短、中下肺野在影像学上呈现模糊的对称性颗粒状阴影、气流受限但DLCO不降低、血清冷凝集素滴度升高，和/或细支气管狭窄伴淋巴细胞和泡沫状肺泡巨噬细胞浸润。这些患者在厚生省（MHW）的DPB研究组进行了登记。采用广义Wilcoxon检验对生存率进行统计学比较。C组的生存率显著高于A组（p < 0.0001）和B组（p < 0.0001）。在C组中，87例患者中有8例死亡；5例死于未接受EM治疗的亚组（n = 24），3例死于接受EM治疗的亚组（n = 63）。C组两个亚组的生存率有显著差异（p < 0.001）。EM治疗与DPB患者生存率的显著提高相关。EM治疗的疗效提高了DPB患者的生存率，在老年患者中比在年轻患者中更显著。
