克拉霉素对儿童哮喘急性发作的影响：一项开放、随机研究
2012/05/08
背景：哮喘发作是哮喘死亡和哮喘难治的主要原因。有关大环内酯类抗生素通过杀菌和/或抗炎特性对哮喘发作产生治疗作用尚未有定论。本试验在急性哮喘患儿中，评价克拉霉素作为辅助用药治疗中期哮喘的疗效。
方法：本试验为初步、开放标记、随机、前瞻性研究，入选40名学龄期儿童。入选者诊断有急性发作的间歇性或轻度持续哮喘。患儿随机分为15 mg/kg克拉霉素治疗3周组和常规GINA为指导的哮喘发作治疗组。微生物触发的哮喘发作采用血清学指标和PCR评价。患儿通过日记卡随访12周，在就诊时、哮喘发作3周及12周时评价肺功能。
结果：在整个随访期，与对照组患儿相比，克拉霉素治疗组患儿，无症状天数显著增加（78±2 vs. 69±6天, p<0.00001），哮喘失控的次数也较少（分别为9 vs. 19, p=0.013）。此外，克拉霉素治疗的患儿发作持续时间更短（5.0±1 vs. 7.5±1天, p<0.00001），但两组间在肺功能上无显著差异。
结论：作为哮喘常规治疗的辅助，为期3周的克拉霉素治疗能增加无症状天数、减少哮喘失控的次数和哮喘严重程度，同时哮喘发作的持续时间也缩短。
方法：本试验为初步、开放标记、随机、前瞻性研究，入选40名学龄期儿童。入选者诊断有急性发作的间歇性或轻度持续哮喘。患儿随机分为15 mg/kg克拉霉素治疗3周组和常规GINA为指导的哮喘发作治疗组。微生物触发的哮喘发作采用血清学指标和PCR评价。患儿通过日记卡随访12周，在就诊时、哮喘发作3周及12周时评价肺功能。
结果：在整个随访期，与对照组患儿相比，克拉霉素治疗组患儿，无症状天数显著增加（78±2 vs. 69±6天, p<0.00001），哮喘失控的次数也较少（分别为9 vs. 19, p=0.013）。此外，克拉霉素治疗的患儿发作持续时间更短（5.0±1 vs. 7.5±1天, p<0.00001），但两组间在肺功能上无显著差异。
结论：作为哮喘常规治疗的辅助，为期3周的克拉霉素治疗能增加无症状天数、减少哮喘失控的次数和哮喘严重程度，同时哮喘发作的持续时间也缩短。
（刘国梁 审校）
Pediatr Allergy Immunol. 2012 Mar 21. doi: 10.1111/j.1399-3038.2012.01280.x. [Epub ahead of print]
Pediatr Allergy Immunol. 2012 Mar 21. doi: 10.1111/j.1399-3038.2012.01280.x. [Epub ahead of print]
Koutsoubari I, Papaevangelou V, Konstantinou GN, Makrinioti H, Xepapadaki P, Kafetzis D, Papadopoulos NG.
Source
Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece.
Abstract
BACKGROUND: Asthma exacerbations are major contributors to asthma morbidity and rather difficult to treat. There is inconclusive evidence that macrolide antibiotics may have an effect on asthma exacerbations through their antibacterial and/or anti-inflammatory properties. The aim of the study was to evaluate the efficacy of clarithromycin on medium-term asthma activity when given as an add-on therapy in children with acute asthma.
METHODS: This pilot, open-labeled, randomized, prospective study included 40 school-aged children, with intermittent or mild persistent asthma, presenting with an acute exacerbation. Children were randomized to receive 15 mg/kg of clarithromycin for 3 wk, in addition to their regular (GINA-guided) exacerbation treatment. The microbial trigger of exacerbations was assessed by serology and PCR. Children were followed up with diary cards for 12 wk; lung function was assessed at entry, 3, and 12 wk after the exacerbation.
RESULTS: Children in the clarithromycin group had significantly more symptom-free days (78±2 vs. 69±6 days, p<0.00001) and less total number of periods with loss of control (9 vs. 19, respectively, p=0.013) during the follow-up period, compared to controls. Moreover, treated children presented reduced duration of the index episode (5.0±1 vs. 7.5±1 days, p<0.00001). Lung function did not differ between groups.
CONCLUSIONS: When added to regular treatment, a 3-wk course of clarithromycin was associated with an increase in the number of symptom-free days, reductions in the number and severity of days with loss of control following index episode, and a decrease in the duration of the initial asthma exacerbation.
Pediatr Allergy Immunol. 2012 Mar 21. doi: 10.1111/j.1399-3038.2012.01280.x. [Epub ahead of print]
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