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目的:研究阿奇霉素维持治疗对不同高分辨率CT(HRCT)表型稳定期慢性阻塞性肺疾病(COPD)患者急性加重频次、肺功能的影响。方法:本研究为前瞻性、随机、双盲、安慰剂对照、单中心临床试验。选取2013年5月至2018年5月于河北中石油中心医院呼吸与危重症医学科住院或门诊治疗好转的COPD稳定期患者110例进行研究。110例入组前1年急性发作≥2次、肺功能分级≥2级的稳定期COPD患者按随机数字表法分为阿奇霉素组(n n＝58)以及安慰剂组(n n＝52)。患者在常规治疗的基础上随机给予阿奇霉素(500 mg口服，每周3次，持续1年)或给予安慰剂(500 mg口服，每周3次，持续1年)，同时通过HRCT将入组患者分为A型(n n＝39)，E型(n n＝38)，M型(n n＝33)。比较阿奇霉素维持治疗后对3种表型患者1年急性发作频次、第一次急性加重时间、肺功能的影响。n 结果:(1)阿奇霉素组与安慰剂组COPD患者1年的急性加重频次、第一次急性加重中位时间及第1秒用力呼气容积下降，差异均有统计学意义(n Z＝-4.28，n χ2＝6.53，n t＝12.73，n P值均<0.05)；(2)M型患者阿奇霉素组与安慰剂组急性加重频次、第一次急性重中位时间及FEVn 1下降，差异均有统计学意义(n Z＝-3.43，n χ2＝13.69，n t＝21.56，n P值均0.05)。n 结论:阿奇霉素维持治疗稳定期COPD患者可降低患者急性发作频次、延长第1次急性发作时间，延缓FEVn 1下降；且在HRCT的M型患者中效果明显。n “,”Objective:To investigate the clinical significance of azithromycin maintenance therapy on chronic obstructive pulmonary disease(COPD) with different high resolution computer tomography (HRCT) phenotypes.Methods:This study was a prospective, randomized, double-blind, placebo-controlled, single-center clinical trial participants with stable, frequent exacerbations and GOLD≥ 2 grade were divided into azithromycin group (n n=58 ) and placebo group (n n=52) randomly.Subjects were randomly given azithromycin (500 mg, three times per week, for 1 year) or placebo (500 mg, three times per week, for 1 year) on the usual care.At the same time participants were classified into three phenotypes by HRCT type A (n n=39), type E (n n=38), type M (n n=33). The differences of the frequency rate of acute exacerbations, lung function between the three phenotypes after azithromycin maintenance therapy were compared.n Results:(1)The frequency rate of AECOPD per-person yearly between azithromycin group and the placebo group, media time to first acute exacerbation and the forced expiratory volume in one second (FEVn 1)declines were different significantly (n Z=-4.28, n χ2=6.53, n t=12.73, all n P<0.05). (2)The frequency rate of AECOPD per-person yearly between azithromycin group and the placebo group in phenotype M, media time to first acute exacerbation and the FEVn 1 declines were different significantly (n Z=-3.43, n χ2=13.69, n t=21.56, all n P0.05).n Conclusions:Azithromycin maintenance therapy can reduce the frequency rate of acute exacerbations, prolong the time to first exacerbation, lower the declines of FEVn 1 in stable COPD participants.The therapeutic efficacy is obvious in M phenotype of HRCT.n