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弥漫性全细支气管炎(DPB)是以慢性细支气管炎和肺中炎症细胞慢性浸润为特征的肺疾病。DPB与襄性纤维变性(CF)有几个共同的特征,对DPB或CF患者的临床试验提出维持性(长期低剂量)大环内酯治疗对这些慢性肺病的有益作用。研究已证实用大环内酯治疗改善了DPB或CF患者临床和生理状态。长期低剂量大环内酯治疗的有益作用与它们的抗菌性质无关。体外和间接体内(exvivo)研究表明大环内酯具有免疫调节作用:会影响各类细胞因子的产生;能改变多形核细胞功能。免疫作用可以作为大环内酯对慢性肺炎患者有益作用的第一种解释,低剂量大环内酯治疗对生物膜形成的影响可以是第二种解释。对用维持性大环内酯治疗DPB或CF患者的临床试验进行了综述,讨论了大环内酯免疫调节作用和大环内酯对生物膜形成的影响。
Diffuse total bronchiolitis (DPB) is a lung disease characterized by chronic bronchitis and chronic infiltration of inflammatory cells in the lungs. There are several common features of DPB and focal fibrosis (CF) that suggest beneficial effects of maintenance (long-term, low-dose) macrolide therapy on these chronic lung diseases in clinical trials of DPB or CF patients. Studies have demonstrated that treatment with macrolides improves the clinical and physiologic status of DPB or CF patients. The beneficial effects of long-term low-dose macrolide treatment have nothing to do with their antibacterial properties. In vitro and ex vivo studies have shown that macrolides have immunomodulatory effects that affect the production of various cytokines and alter the function of polymorphonuclear cells. The first explanation for the beneficial effects of macrolides on patients with chronic pneumonia may be the immunological effect. The effect of low-dose macrolide treatment on biofilm formation may be the second explanation. The clinical trials of patients with DPB or CF treated with sustained macrolide were reviewed, and the immunomodulatory effects of macrolides and the effects of macrolides on biofilm formation were discussed.