阿奇霉素对慢性阻塞性肺疾病急性加重患者的免疫调节作用研究

中国临床药理学与治疗学 ›› 2013, Vol. 18 ›› Issue (11): 1288-1290.

阿奇霉素对慢性阻塞性肺疾病急性加重患者的免疫调节作用研究

钱小英, 吴厉锋, 徐滨

温州市人民医院呼吸内科,温州 325000,浙江

收稿日期:2012-11-26 修回日期:2013-08-10 出版日期:2013-11-26 发布日期:2013-11-22
作者简介:钱小英,女,硕士,副主任医师,研究方向:呼吸疾病的治疗。Tel: 0577-88059942 E-mail: wzqxy31et@126.com

The immunomodulatory role of azithromycin in acute exacerbations of chronic obstructive pulmonary disease

QIAN Xiao-ying, WU Li-feng, XU Bin

Department of Respiratory Medicine, Wenzhou People's Hospital, Wenzhou 325000, Zhejiang, China

Received:2012-11-26 Revised:2013-08-10 Online:2013-11-26 Published:2013-11-22

摘要/Abstract

摘要： 目的: 观察阿奇霉素对慢性阻塞性肺疾病急性加重期(AECOPD)患者的临床疗效,并探讨其对患者免疫功能的调节作用。方法: 收集本院呼吸内科2010年6月-2012年6月诊治的AECOPD患者76例,随机分成2组:常规治疗对照组(A,n=38)和阿奇霉素治疗组(B,n=38)。另取本院体检中心健康体检者作为正常对照组(C,n=30)。比较两组的临床疗效和不良反应。ELISA法测定IL-17和转化生长因子-β₁(TGF-β₁)的表达。结果: A组和B组的临床治疗有效率分别为 63.2%和 84.2%,B组的临床疗效显著优于A组(P<0.05)。A和B组治疗前IL-17和TGF-β₁表达水平与C组之间存在统计学差异(P<0.01),治疗后A和B组IL-17表达水平较治疗前显著减低(P<0.05),TGF-β₁表达水平则显著升高(P<0.05),但B组治疗后IL-17表达水平显著低于A组治疗后的表达水平(P<0.01),TGF-β₁表达水平则显著高于A组治疗后的表达水平(P<0.05)。A组和B组的不良反应发生率分别为 7.9%和 10.5%,两组之间无统计学差异(P>0.05)。结论: 阿奇霉素治疗AECOPD临床疗效显著,调节IL-17/ TGF-β₁平衡紊乱可能是其疗效显著的主要作用机制。

关键词: 慢性阻塞性肺疾病急性加重期, 阿奇霉素, IL-17, 转化生长因子-β₁

Abstract: AIM: To investigate the clinical efficacy of azithromycin in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and explore its immunomodulatory role.METHODS: 76 cases of AECOPD patients were enrolled in this study. All the 76 cases were divided into two groups: control treatment group (A, n=38) and azithromycin treatment group(B, n=38). Another 30 healthy person were used as normal control group (C, n=30). The clinic efficacy and effects of drugs was compared between the two groups. The serum levels of IL-17 and TGF-β₁ was measured with ELISA analysis.RESULTS: The clinic efficacy in group A and B was 63.2% and 84.2%, respectively, which was higher in group B than in group A (P<0.05). The serum levels of IL-17 and TGF-β₁ in group A and B were significantly different as compared with group C at pretreatment (P<0.05). Compared with pretreatment, in group A and B the IL-17 level was significantly decreased (P<0.05), and TGF-β₁ level was significantly increased (P<0.05) at post-treatment. At post-treatment, the IL-17 level was significantly lower in group B than that in group A (P<0.01), and the TGF-β₁ level was significantly higher in group B than that in group A (P<0.05). The incidence of side effects in group A and B were 7.9% and 10.5%, respectively. There was no significant difference between the two groups (P<0.05).CONCLUSION: Azithromycin showed more effectively clinical efficacy on AECOPD patients. The regulation of IL-17/TGF-β₁ balance disorder may play a key role on the mechanism of its significant effect.

Key words: Acute exacerbations of chronic obstructive pulmonary disease, Azithromycin, IL-17, TGF-β₁

中图分类号:

R563

钱小英, 吴厉锋, 徐滨. 阿奇霉素对慢性阻塞性肺疾病急性加重患者的免疫调节作用研究[J]. 中国临床药理学与治疗学, 2013, 18(11): 1288-1290.

QIAN Xiao-ying, WU Li-feng, XU Bin. The immunomodulatory role of azithromycin in acute exacerbations of chronic obstructive pulmonary disease[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2013, 18(11): 1288-1290.

参考文献

[1] Rabe KF, Hurd S, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary[J]. Am J Respir Crit Care Med, 2011, 176(6): 532-555.
[2] 柳涛, 蔡柏蔷. 慢性阻塞性肺疾病诊断、处理和预防全球策略(2011年修订版) 介绍[J]. 中国呼吸与危重监护杂志, 2012, 11(1): 1-12.
[3] Provinciali M, Cardelli M, Marchegiani F. Inflammation, chronic obstructive pulmonary disease and aging[J]. Curr Opin Pulm Med, 2011, 17( Suppl 1): S3-10.
[4] 金玲湘, 颜雪琴, 翁海霞. 小剂量阿奇霉素长期使用治疗慢性呼吸道感染疾病的安全性探讨[J]. 中国临床药理学与治疗学, 2003, 8(2):213-214.
[5] 肖国宏, 孙利华, 陈敦金, 等. 阿奇霉素治疗沙眼衣原体感染孕鼠对其妊娠结局及免疫状态的影响[J]. 现代妇产科进展, 2010, 19(2): 87-91.
[6] 中华医学会呼吸病学分会. 慢性阻塞性肺疾病诊治指南(2007年修订版)[J]. 中华结核和呼吸杂志, 2007, 30(1): 8-17.
[7] 潘丽娜, 时国朝. 慢性阻塞性肺疾病与自身免疫[J]. 中国呼吸与危重监护杂志, 2011, 10(3): 296-298.
[8] Vargas-Rojas MI, Ramirez-Venegas A, Limon-Camacho L, et al. Increase of Th17 cells in peripheral blood of patients with chronic obstructive pulmonary disease[J]. Respir Med, 2011, 105(11): 1648-1654.
[9] Yamada H. Current perspectives on the role of IL-17 in autoimmune disease[J]. J Inflamm Res, 2010, 3(1): 33-44.
[10] Nujic K, Banjanac M, Munic V, et al. Impairment of lysosomal functions by azithromycin and chloroquine contributes to anti-inflammatory phenotype[J]. Cell Immunol, 2012, 279(1): 78-86.
[11] Vrancic M, Banjanac M, Nujic K, et al. Azithromycin distinctively modulates classical activation of human monocytes in vitro[J]. Br J Pharmacol, 2012, 165(5): 1348-1360.
[12] Pomares X, Monton C, Espasa M, et al. Long-term azithromycin therapy in patients with severe COPD and repeated exacerbations[J]. Int J Chron Obstruct Pulmon Dis, 2011, 6(2): 449-456.

[1]	王铁烽, 苏洁, 王伟东, 夏荣双, 李思凡, 朱文瑞, 楼招欢. 三叶青调节Th17/Treg平衡抗类风湿性关节炎的作用及机制研究[J]. 中国临床药理学与治疗学, 2023, 28(2): 138-146.
[2]	邰宇, 张子璇, 张玲玲. 银屑病关节炎治疗进展[J]. 中国临床药理学与治疗学, 2020, 25(12): 1395-1407.
[3]	张文喜，刘东红，赵蓓，赵佳佳，蔡俏，高未，蔡奔奔. 阿奇霉素联合甲强龙治疗支原体肺炎肺实变患儿的随机对照临床试验[J]. 中国临床药理学与治疗学, 2018, 23(9): 1052-1055.
[4]	陆威，周炳荣，汤怡，樊一斌，陶小华. Th17细胞在痤疮发病中的作用及与痤疮严重度相关性的功能研究[J]. 中国临床药理学与治疗学, 2018, 23(1): 83-87.
[5]	李娜，刘桢宇，胡文，陈春林. 氨曲南联用阿奇霉素对产膜铜绿假单胞菌作用的实验研究[J]. 中国临床药理学与治疗学, 2017, 22(12): 1400-1405.
[6]	罗玲玲，滕承志，李晓笑，潘丹峰. 阿奇霉素联合盐酸氨溴索治疗小儿支原体肺炎合并急性支气管炎的临床研究[J]. 中国临床药理学与治疗学, 2017, 22(11): 1278-1282.
[7]	陈雪松, 吴宁, 齐玉琴, 张兴虎, 万文辉, 钱晓明. 慢性阻塞性肺病稳定期患者外周血Th17/Treg失衡情况及与预后的关系[J]. 中国临床药理学与治疗学, 2014, 19(12): 1383-1388.
[8]	庄让笑, 王福根, 邵益丹, 方红英, 孙晶晶, 席建军, 潘金明, 梁伟峰, 刘寿荣. 乙酰半胱氨酸镁盐-甘草酸环状样二聚体治疗大鼠肝纤维化的实验研究[J]. 中国临床药理学与治疗学, 2014, 19(12): 1337-1341.
[9]	刘艳, 杨解人, 郝伟, 张俊秀, 唐丽娟, 陈国祥. 复方山菊对自发性高血压大鼠主动脉损伤的保护作用及机制[J]. 中国临床药理学与治疗学, 2013, 18(7): 732-737.
[10]	郑美梅, 王方剑, 岳铁刚, 董丽妍, 段成城. 阿奇霉素对支气管哮喘患者肺功能及血清结缔组织生长因子的影响[J]. 中国临床药理学与治疗学, 2013, 18(2): 194-197.
[11]	杨沿浪, 邹和群, 张道友, 汪裕伟, 李芳霞, 高超清, 徐海红, 陈小妹. 贝那普利、螺内酯联用对阿霉素肾病大鼠肾小管保护作用的研究[J]. 中国临床药理学与治疗学, 2012, 17(4): 381-386.
[12]	凌佼佼, 李平华. 银杏叶提取物对TGF-β₁诱导的人Tenon's囊成纤维细胞增殖的影响及其机制的初步探讨[J]. 中国临床药理学与治疗学, 2011, 16(12): 1347-1351.
[13]	孙璐, 胡艳玲, 杨亚楠, 包凯. 液相色谱-电喷雾离子阱质谱法研究人尿中阿奇霉素的主要代谢产物[J]. 中国临床药理学与治疗学, 2009, 14(9): 984-989.
[14]	杨沿浪, 张道友, 汪向明, 崔明春, 吴小东. 苯那普利及己酮可可碱对阿霉素肾病大鼠的肾脏保护作用[J]. 中国临床药理学与治疗学, 2009, 14(7): 736-740.
[15]	徐红蕾, 金旭如, 陈少贤. 曲尼司特抗大鼠肺纤维化的作用及机制[J]. 中国临床药理学与治疗学, 2009, 14(7): 754-759.