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目的观察长期口服小剂量红霉素对支气管扩张症稳定期患者的疗效,并对铜绿假单胞菌定植亚组进行分层分析。方法 42例确诊为支气管扩张症患者,对照组口服安慰剂30mg,每日2次;治疗组口服红霉素肠溶片0.25g/次,每日2次;疗程均为6个月。观察患者的急性加重次数、24小时痰总量、肺功能、痰细菌清除率及口咽部链球菌对大环内酯类耐药性等变化,并对铜绿假单胞菌定植亚组进行相关分析。结果治疗组急性加重次数、24小时痰总量均显著减少,FEV1、FVC改善,差异均有统计学意义;铜绿假单胞菌定植亚组改善明显;治疗组痰细菌清除率较高;治疗组口咽部链球菌对大环内酯类的耐药率上升了28.57%,较对照组有显著差异(P<0.05)。结论长期口服小剂量红霉素对支气管扩张症稳定期患者可减少急性加重次数及24小时痰总量,改善肺功能,提高痰菌清除率;亚组分析显示,铜绿假单胞菌定植亚组经治疗后获益更大;治疗后口咽部大环内酯类耐药链球菌比例明显升高。
Objective To observe the effect of long-term oral administration of low dose erythromycin on patients with stable bronchiectasis and stratify the subgroups of Pseudomonas aeruginosa colonization. Methods Forty-two patients with bronchiectasis were diagnosed. The control group was given placebo 30 mg orally twice daily. The treatment group received erythromycin enteric-coated tablets 0.25g twice daily for 6 months. The number of acute exacerbations, 24-hour sputum volume, lung function, sputum bacterial clearance and the resistance of macrolides to oropharyngeal streptococci were observed, and the association of Pseudomonas aeruginosa colonization subgroup was made analysis. Results In the treatment group, the number of acute exacerbations and the total amount of sputum in 24 hours were significantly decreased, FEV1 and FVC were improved, the differences were statistically significant; Pseudomonas aeruginosa colonization subgroup significantly improved; the sputum bacterial clearance rate was higher in the treatment group; The resistance rate of ornithin to macrolides increased by 28.57%, which was significantly different from the control group (P <0.05). Conclusion Long-term low-dose oral administration of erythromycin in patients with stable bronchiectasis can reduce the number of acute exacerbations and 24-hour sputum, improve lung function and improve sputum clearance rate; subgroup analysis showed that Pseudomonas aeruginosa colonization subgroup After treatment benefit more; treatment of oropharyngeal macrolide resistant Streptococcus increased significantly.