长期口服大环内酯类药物对慢性气流阻塞性肺疾病的作用解决方案.pptVIP

Macrolide Therapy in Adults and Children with Non- Cystic Fibrosis Bronchiectasis 9 篇研究 成人6篇 儿童3篇 559例患者 Clinical characteristics of the 9 trials Source Total /Treated subjects (n) Therapy strategy Dose Control Course Koh 1997 25/13 Roxithromycin 4mg/kg,bid placebo 12wks Tsang 1999 21/11 Erythromycin 500mg,bid placebo 8wks Cymbala 2005 22/11 Azithromycin 500mg,2/w crossover 6ms Wong 2012 141/71 Azithromycin 500mg,3/w placebo 6ms Altenburg 2013 83/43 Azithromycin 250mg,qd placebo 52wks Serisier 2013 117/59 Erythromycin 400mg,bid placebo 48wks Masekela 2013 31/17 Erythromycin 125/250mg, qd placebo 52wks De Diego 2013 30/16 Azithromycin 250mg,3/w Usual care 3ms Valer 2013 89/45 Azithromycin 30mg/kg,qw placebo 12-24ms 长期口服大环内酯类药物可减少支气管扩张急性加重患者的人数 长期口服大环内酯类药物可减少支气管扩张患者急性加重次数 次要终点指标 未减少支气管扩张急性加重住院的风险 显著改善生活质量 显著改善成人支气管舒张试验前/后FEV1 显著改善成人支气管舒张试验前/后FVC 未改善6分钟步行距离 Subgroup analysis 急性加重患者数 每年急性加重患者比例 Side effects 口服大环内酯患者腹部不良反应增加 Mechanism Conclusion 长期口服大环内酯类药物可减少慢性气流阻塞性疾病患者急性加重 应用疗程应超过6个月 长期口服大环内酯类药物有可能导致轻度不良反应 长期口服大环内酯类药物对细菌定植及耐药的影响还有待验证 * 罗红霉素 * 近年来发现，红霉素（EM）及其新衍生物对许多非细菌感染性疾病有一定作用。 No significant FVC changes were observed in the first 3 months of follow up. The random-effects model was applied for all reports. Combining four studies (N 1?4 368), azithromycin showed increase in FEV1 (3.53%, 95% CI 0.00, 7.07, p 1?4 0.05; I2 1?4 38%) and FVC (4.24%, 95% CI 2.02, 6.45, p 1?4 0.0002; I2 1?4 0%). When trials were analyzed by baseline Pseudomonas sputum colonization, the heterogeneity decreased (I2 1?4 0%), FEV1 significantly increased to 4.66% (95% CI 1.18, 8.15, p 1?4 0.009), and FVC increased to 4.64% (95% CI 2.11, 7.17, p 1?4 0.0003). Azithromycin showed an overall significant 3.53% increase in FEV1 (95% CI 0.00, 7.07, p 1?4 0.05; I2 1?4 38%) (Fig. 2). No significant FEV1 changes were observed in the first 3 months of follow up. When FEV1 changes were analyzed by the baseline Pseudomonas sputum colonization (Fig. 3), heterogeneity decreased, and the FEV1 increa