Effect of Azithromycin on Systemic Markers of Inflammation in Patients With Cystic Fibrosis Uninfected With Pseudomonas aeruginosa-猫眼课题宝

DOI：

10.1378/chest.12-0628

发表时间：

2012-11-01

期刊：

CHEST

影响因子：

9.6

通讯作者：

中科院分区：

医学1区

文献类型：

作者：

Ratjen, Felix;Saiman, Lisa;Anstead, Michael

背景资料：虽然阿奇霉素对囊性纤维化患者发挥积极作用的作用机制尚不清楚，但有证据表明阿奇霉素可能作为一种免疫调节剂。我们在一项口服阿奇霉素的双盲、随机、对照试验中检测了未感染铜绿假单胞菌的6-18岁囊性纤维化患者全身炎症标志物的变化。WBC计数和分类、血清髓过氧化物酶（MPO）、高敏C反应蛋白（hsCRP）、细胞内粘附分子1、IL-6、钙卫蛋白、血清淀粉样蛋白A（SAA），和粒细胞集落刺激因子（G-CSF）分别在基线和治疗后28和168天在患者接受口服阿奇霉素或安慰剂。与安慰剂组相比，阿奇霉素组的HsCRP、MPO、SAA、钙卫蛋白和中性粒细胞绝对计数（ANC）从基线至第28天显著降低（P <0.05）。对于ANC、钙卫蛋白和SAA，这种治疗效果在第168天持续（P < .05）。第28天hsCRP、钙卫蛋白和SAA的变化与FEV 1（L）和FEV 1（%预测值）的变化以及体重的绝对和相对变化呈负相关（P <0.05）。除体重（%）外，钙卫蛋白的相关性仍然显著; FEV 1（L）和体重（%）与hsCRP的168天变化仍然显著相关。ANC的168天的变化与肺功能的变化显着相关，但不是在重量;在G-CSF的变化显着相关的变化在重量（%）ONLY. CONCLUSION：在未感染铜绿假单胞菌的患者，口服阿奇霉素显着减少中性粒细胞计数和肺泡炎性标志物在28天内开始治疗。试验登记处：ClinicalTrials.gov;编号：NCT 00431964; URL：www.clinicaltrials.gov CHEST 2012; 142（5）：1259-1266

Background: While the mechanism of action by which azithromycin exerts positive effects in patients with cystic fibrosis remains unclear, evidence suggests that azithromycin may act as an immunomodulatory agent. We examined changes in systemic inflammatory markers in a double-blind, randomized, controlled trial of oral azithromycin in patients 6-18 years of age with cystic fibrosis who were uninfected with Pseudomonas aeruginosa.Methods: WBC counts and differential, serum myeloperoxidase (MPO), high-sensitivity C reactive protein (hsCRP), intracellular adhesion molecule 1, IL-6, calprotectin, serum amyloid A (SAA), and granulocyte colony-stimulating factor (G-CSF) were measured at baseline and after 28 and 168 days of treatment in patients receiving either oral azithromycin or placebo.Results: Inflammatory markers were similar in both groups at baseline. HsCRP, MPO, SAA, calprotectin, and the absolute neutrophil count (ANC) significantly decreased from baseline to day 28 in the azithromycin group compared with the placebo group (P < .05). This treatment effect was sustained at day 168 for ANC, calprotectin, and SAA (P < .05). Changes in hsCRP, calprotectin, and SAA at day 28 were negatively correlated with changes in FEV1 (L) and FEV1 (% predicted), as well as both absolute and relative changes in weight (P < .05). Except for weight (%), the associations remained significant for calprotectin; FEV1(L) and weight (%) remained significantly correlated with the 168-day change in hsCRP. The 168-day change in ANC was significantly correlated with changes in lung function, but not in weight; the change in G-CSF was significantly correlated with the change in weight (%) only.Conclusions: In patients not infected with P aeruginosa, oral azithromycin significantly reduced neutrophil counts and scrum inflammatory markers within 28 days of initiating treatment. Trial registry: ClinicalTrials.gov; No.: NCT00431964; URL: www.clinicaltrials.gov CHEST 2012; 142(5):1259-1266

Effect of Azithromycin on Systemic Markers of Inflammation in Patients With Cystic Fibrosis Uninfected With Pseudomonas aeruginosa

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