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目的探讨克拉霉素在慢性阻塞性肺疾病(COPD)治疗中的作用。方法 108例COPD随机分为两组:A组56例,在基础治疗的基础上加服克拉霉素;B组52例,仅用基础治疗。C组45例,为健康体检者对照组。治疗前及治疗8周后测定血清白细胞介素(IL)-8、IL-6,肿瘤坏死因子(TNF)-α、T淋巴细胞亚群(CD3+,CD4+,CD8+)和CD4+/CD8+比值及FEV1.0和FEV1.0/FVC。结果治疗前,A、B组患者血清IL-8、TNF-α、IL-6、CD8+T淋巴细胞较C组升高,FEV1.0、FEV1.0/FVC较C组下降。克拉霉素治疗后,A组IL-8、TNF-α、IL-6、CD8+T淋巴细胞减低,FEV1.0、FEV1.0/FVC高于治疗前及B组(P<0.01)。IL-8、TNF-α、IL-6、CD8+T淋巴细胞与FEV1.0、FEV1.0/FVC呈负相关,CD4+/CD8+比值与FEV1.0、FEV1.0/FVC呈正相关。结论应用克拉霉素可以降低稳定期COPD患者的IL-8、TNF-α、IL-6的含量,抑制炎症反应,调节细胞免疫功能并能改善肺功能。
Objective To investigate the role of clarithromycin in the treatment of chronic obstructive pulmonary disease (COPD). Methods 108 cases of COPD were randomly divided into two groups: A group of 56 cases, based on the basic treatment plus taking clarithromycin; B group 52 cases, only basic treatment. 45 cases in group C were healthy control subjects. Serum interleukin (IL) -8, IL-6, tumor necrosis factor (TNF) -α, T lymphocyte subsets (CD3 +, CD4 +, CD8 +) and CD4 + / CD8 + and FEV1 .0 and FEV1.0 / FVC. Results Before treatment, the levels of IL-8, TNF-α, IL-6 and CD8 + T lymphocytes in group A and group B were higher than those in group C, and FEV1.0 and FEV1.0 / FVC were lower than those in group C. After clarithromycin treatment, the levels of IL-8, TNF-α, IL-6 and CD8 + T lymphocytes in group A were decreased, FEV1.0 and FEV1.0 / FVC were higher than those before treatment and in group B (P <0.01). The levels of IL-8, TNF-α, IL-6 and CD8 + T lymphocytes were negatively correlated with FEV1.0 and FEV1.0 / FVC. The ratio of CD4 + / CD8 + was positively correlated with FEV1.0 and FEV1.0 / FVC. Conclusion Clarithromycin can reduce the levels of IL-8, TNF-α and IL-6 in patients with stable COPD, inhibit the inflammatory reaction, regulate cellular immunity and improve pulmonary function.