目的 觀察阿奇霉素對支氣管擴(kuò)張患者的臨床療效和安全性，并探討了其可能的抗炎機(jī)制。方法 收集張家港市中醫(yī)醫(yī)院呼吸內(nèi)科2015年2月-2016年2月收治的支氣管擴(kuò)張癥患者94例，使用數(shù)字表法將96例患者隨機(jī)分為對照組和觀察組，每組47例。對照組給予吸氧、止咳、化痰、等常規(guī)治療，體位引流、震動拍擊、主動呼吸訓(xùn)練，吸氣肌訓(xùn)練等物理治療促進(jìn)排痰；觀察組在對照組基礎(chǔ)上給予阿奇霉素250 mg/次，1次/d，療程12個月。ELISA法檢測p65和IL-6，比較兩組治療前、后的呼吸困難量表（mMRC）評分、肺功能、痰液量、痰液密度和性狀評分及不良反應(yīng)。結(jié)果 治療后對照組p65和IL-6表達(dá)較治療前無顯著性變化，但觀察組p65和IL-6表達(dá)較治療前顯著減低，同組治療前后比較差異有統(tǒng)計學(xué)意義（P<0.05）。對照組呼吸困難評分治療后顯著減低，同組治療前后比較差異有統(tǒng)計學(xué)意義（P<0.05），F(xiàn)EV1/FVC和FVE1/pred治療后變化無統(tǒng)計學(xué)意義；觀察組呼吸困難評分治療顯著減低，F(xiàn)EV1/FVC和FVE1/pred治療后顯著升高，同組治療前后比較差異有統(tǒng)計學(xué)意義（P<0.05）。治療后觀察組痰液密度評分、痰液性狀評分和痰液量均顯著低于對照組，差異有統(tǒng)計學(xué)意義（P<0.05）。觀察組不良反應(yīng)發(fā)生率為10.6%（5/47），對照組為8.5%（4/47），兩組間無顯著性差異。結(jié)論 阿奇霉素長期治療支氣管擴(kuò)張可以顯著改善肺功能，使用安全，抑制NF-κB通路，可能是其減輕氣道炎癥反應(yīng)的主要機(jī)制。

Objective To detect the clinical efficacy azithromycin on patients with bronchiectasis and explore its mechanism.Methods A total of 94 patients with bronchiectasis were enrolled in this study. The patients were randomly divided into observation group and control group, 47 cases in each group. The expression of p65, hs-CRP, and IL-6 was detected by ELISA analysis. The pulmonary function index and adverse reaction were compared between the two groups.Results There was no difference of p65 and IL-6 between before and after treatment in control groups. After treatment, p65, hs-CRP, and IL-6 was lower in observation group than that in control group (P< 0.05). After treatment, dyspnea score was lower in observation group than that in control group (P< 0.05), and FEV1/FVC and FVE1/pred was higher in observation group than that in control group (P< 0.05). After treatment, sputum density score, sputum character score, sputum volume was lower in observation group than that in control group (P< 0.05). The rate of adverse reaction was 10.6% (5/47) in observation group and 8.5% (4/47) in control group. There was no difference between the two groups.Conclusion Long term treatment of bronchiectasis with azithromycin can improve pulmonary function, inhibit NF-kB pathway to reduce airway inflammatory response, and with significant safety.