支气管哮喘患儿低剂量红霉素治疗的指征和有效性
2010/09/14
摘要
为阐明难治性儿童支气管哮喘的机制和低剂量红霉素（EM）治疗的指征，我们对55名儿童支气管哮喘患者进行了研究。这些儿童采用激素吸入、白三烯受体拮抗剂、茶碱和其他药物治疗超过1年，其平均年龄为7.4±3.5岁，检测血清趋化因子和促血管生成因子的水平进行评估。严重哮喘患儿的白介素8（IL-8）(p = 0.036)和血管内皮生长因子（VEGF）(p = 0.005) 显著高于轻症的哮喘患儿，而其他趋化因子的水平，如血清嗜酸性粒细胞趋化因子和MCP1与支气管哮喘的严重程度无关。低剂量EM治疗6个月内，明显改善严重哮喘患者的临床症状，降低了血清趋化因子水平：白介素8（IL-8）从736±88 pg/ml降低至75±85 pg/ml (p < 0.0005)；VEGF从352.0 ±160.5 pg/ml降低至132.2±59.9 pg/ml (p = 0.021)。此外，低剂量EM治疗能减少每天血清茶碱浓度的峰谷波动率（Cmax- Cmin）/Cmin：从1.3±0.5降至0.5±0.3），因此维持了有效的血清药物浓度水平。
这些结果显示，白介素8和VEGF能影响难治性支气管哮喘的严重程度。低剂量EM治疗通过抑制这些趋化因子，维持有效的茶碱水平，能改善支气管哮喘的症状。
（苏楠 审校）
Pediatr Allergy Immunol. 2010 May;21(3):489-492.
The indication and effectiveness of low-dose erythromycin therapy in pediatric patients with bronchial asthma
Korematsu S, Yamamoto K, Nagakura T, Miyahara H, Okazaki N, Akiyoshi K, Maeda T, Suenobu S, Izumi T.
Department of Pediatrics and Child Neurology, Oita University, Oita, Japan. kseigo@med.oita-u.ac.jp
Abstract
To elucidate the mechanisms of intractable pediatric bronchial asthma and the indication of low-dose erythromycin (EM) therapy, the serum chemokine levels of and the angiogenic factor were evaluated in 55 pediatric patients with bronchial asthma; 7.4 +/- 3.5 yr old, who had been treated with inhaled steroid, leukotriene receptor antagonist, theophylline and others for more than a year. Both the levels of interleukin (IL) 8 (p = 0.036) and vascular endothelial growth factor (VEGF) (p = 0.005) were higher in patients with severe type than those of patients with the milder type, while other chemokine levels such as serum eotaxin and MCP1 did not show the correlation with the severity of bronchial asthma. Induction of therapy with low-dose EM induced improvement of the clinical symptoms in patients with severe type and decrease of their serum chemokine levels: IL8; from 736 +/- 88 to 75 +/- 85 pg/ml (p < 0.0005), and VEGF; from 352.0 +/- 160.5 to 132.2 +/- 59.9 pg/ml (p = 0.021) within the next 6 months. Moreover, low-dose EM resulted in a decreased daily peak-trough fluctuation rate of the serum theophylline concentration; (C(max )- C(min))/C(min), from 1.3 +/- 0.5 to 0.5 +/- 0.3, which led to the maintenance of effective serum levels. These results indicated that IL8 and VEGF affect the severity of standard therapies resistance intractable bronchial asthma. Through the suppression of these chemokines and maintenance of effective theophylline levels, low-dose EM therapy improves the symptoms of bronchial asthma.
Pediatr Allergy Immunol. 2010 May;21(3):489-92.
为阐明难治性儿童支气管哮喘的机制和低剂量红霉素（EM）治疗的指征，我们对55名儿童支气管哮喘患者进行了研究。这些儿童采用激素吸入、白三烯受体拮抗剂、茶碱和其他药物治疗超过1年，其平均年龄为7.4±3.5岁，检测血清趋化因子和促血管生成因子的水平进行评估。严重哮喘患儿的白介素8（IL-8）(p = 0.036)和血管内皮生长因子（VEGF）(p = 0.005) 显著高于轻症的哮喘患儿，而其他趋化因子的水平，如血清嗜酸性粒细胞趋化因子和MCP1与支气管哮喘的严重程度无关。低剂量EM治疗6个月内，明显改善严重哮喘患者的临床症状，降低了血清趋化因子水平：白介素8（IL-8）从736±88 pg/ml降低至75±85 pg/ml (p < 0.0005)；VEGF从352.0 ±160.5 pg/ml降低至132.2±59.9 pg/ml (p = 0.021)。此外，低剂量EM治疗能减少每天血清茶碱浓度的峰谷波动率（Cmax- Cmin）/Cmin：从1.3±0.5降至0.5±0.3），因此维持了有效的血清药物浓度水平。
这些结果显示，白介素8和VEGF能影响难治性支气管哮喘的严重程度。低剂量EM治疗通过抑制这些趋化因子，维持有效的茶碱水平，能改善支气管哮喘的症状。
（苏楠 审校）
Pediatr Allergy Immunol. 2010 May;21(3):489-492.
The indication and effectiveness of low-dose erythromycin therapy in pediatric patients with bronchial asthma
Korematsu S, Yamamoto K, Nagakura T, Miyahara H, Okazaki N, Akiyoshi K, Maeda T, Suenobu S, Izumi T.
Department of Pediatrics and Child Neurology, Oita University, Oita, Japan. kseigo@med.oita-u.ac.jp
Abstract
To elucidate the mechanisms of intractable pediatric bronchial asthma and the indication of low-dose erythromycin (EM) therapy, the serum chemokine levels of and the angiogenic factor were evaluated in 55 pediatric patients with bronchial asthma; 7.4 +/- 3.5 yr old, who had been treated with inhaled steroid, leukotriene receptor antagonist, theophylline and others for more than a year. Both the levels of interleukin (IL) 8 (p = 0.036) and vascular endothelial growth factor (VEGF) (p = 0.005) were higher in patients with severe type than those of patients with the milder type, while other chemokine levels such as serum eotaxin and MCP1 did not show the correlation with the severity of bronchial asthma. Induction of therapy with low-dose EM induced improvement of the clinical symptoms in patients with severe type and decrease of their serum chemokine levels: IL8; from 736 +/- 88 to 75 +/- 85 pg/ml (p < 0.0005), and VEGF; from 352.0 +/- 160.5 to 132.2 +/- 59.9 pg/ml (p = 0.021) within the next 6 months. Moreover, low-dose EM resulted in a decreased daily peak-trough fluctuation rate of the serum theophylline concentration; (C(max )- C(min))/C(min), from 1.3 +/- 0.5 to 0.5 +/- 0.3, which led to the maintenance of effective serum levels. These results indicated that IL8 and VEGF affect the severity of standard therapies resistance intractable bronchial asthma. Through the suppression of these chemokines and maintenance of effective theophylline levels, low-dose EM therapy improves the symptoms of bronchial asthma.
Pediatr Allergy Immunol. 2010 May;21(3):489-92.
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