Long-term macrolide antibiotic therapy in the treatment of chronic small airway disease clinically mimicking diffuse panbronchiolitis
Long-term macrolide antibiotic therapy in the treatment of chronic small airway disease clinically mimicking diffuse panbronchiolitis
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DOI：
10.2169/internalmedicine.44.200
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发表时间：
2005-03-01
影响因子：
1.2
通讯作者：
Nasu, M
中科院分区：
文献类型：
--
作者：
Kadota, J;Mukae, H;Nasu, M
目的在目前的研究中，我们研究了长期大环内酯类抗生素治疗慢性小气道疾病（CAD）患者的临床效果，该疾病在临床和放射学上与弥漫性泛细支气管炎（DPB）相似，但在病理学上与DPB不同。根据DPB的临床标准选择了1例日本患者，并在手术肺组织学评价后将其分类为DPB或CAD活组织检查所有患者均接受长期大环内酯类药物治疗，并对DPB和CAD组的治疗结果进行比较。结果两组的临床、实验室、放射学和细菌学特征以及支气管肺泡灌洗液中的嗜中性粒细胞均显著相似。大环内酯类药物长期治疗后，两组患者的临床症状和PaO2均得到改善。DPB患者的第一秒用力呼气量（FEV1）、肺活量（VC）和%VC有显著改善，但CAD患者无改善。DPB患者支气管肺泡灌洗液中的中性粒细胞在治疗后也减少，但在CAD患者中是难治性的。结论基于对大环内酯类药物的不同反应，CAD可能与DPB不同的疾病有关。然而，低剂量大环内酯类药物治疗可用于CAD，以实现临床改善，如呼吸道症状和PaO2。
Objective In the current studies, we investigated the clinical effects of long-term macrolide antibiotic therapy for patients with chronic small airway disease (CAD) that clinically and radiologically mimics but is pathologically distinct from diffuse panbronchiolitis (DPB).Patients and Methods Twenty-one Japanese patients were selected on the basis of clinical criteria for DPB and were categorized as DPB or CAD following histological evaluation of surgical lung biopsies. All patients received long-term macrolide therapy, and therapeutic results were compared for the DPB and CAD groups.Results Clinical, laboratory, radiological, and bacterial features, as well as neutrophilia in bronchoalveolar lavage fluid were strikingly similar in both groups. Longterm treatment with macrolides improved the clinical symptoms and PaO2 in both groups. There was a significant improvement in forced expiratory volume in one second (FEV1), vital capacity (VC), and %VC in patients with DPB but not in patients with CAD. Neutrophilia in bronchoalveolar lavage fluid was also reduced following therapy in DPB patients but was refractory in CAD patients.Conclusion Based on the different responses to macrolides, CAD might be associated with conditions distinct from those of DPB. Nevertheless, low-dose macrolide therapy may be applied in CAD to achieve clinical improvement, such as in respiratory symptoms and PaO2.