目的 研究口服阿奇霉素和羅紅霉素對穩(wěn)定期慢性阻塞性肺疾?。–OPD）的療效、肺功能及炎性因子的差異性。方法 150例穩(wěn)定期COPD患者隨機(jī)分為對照組、羅紅霉素組和阿奇霉素組。對照組給予COPD常規(guī)治療，包括休息、吸氧、戒煙、沙美特羅/氟替卡松吸入劑，每次1吸，每日2次，吸入異丙托溴銨溶液每次500 μg，每日1次、氨茶堿片每次0.1 g，每日3次等；阿奇霉素組在對照組基礎(chǔ)上給予阿奇霉素分散片250 mg，每日1次口服。羅紅霉素組在對照組基礎(chǔ)上給予羅紅霉素軟膠囊300 mg，每日1次。療程均為6月。比較治療前后3組患者肺功能、炎性因子、生活質(zhì)量評分、運(yùn)動(dòng)耐受力及急性加重頻率和首次急性加重時(shí)間間隔。結(jié)果 145例患者完成試驗(yàn)，對照組、羅紅霉素組和阿奇霉素組分別為50、48、47例。治療前，3組患者1 s用力呼氣容積（FEV1）、用力肺活量（FVC）、第1秒用力呼氣容積與用力肺活量比值（FEV1/FVC），白細(xì)胞介素-8（IL-8）、腫瘤壞死因子-α（TNF-α）、C-反應(yīng)蛋白（CRP）、圣喬治問卷（SGRQ）生活質(zhì)量評分和6min步行距離（6MWD）均無顯著性差異。治療后，羅紅霉素組和阿奇霉素組的FEV1、FVC和FEV1/FVC均大于對照組，IL-8、TNF-α和CRP小于對照組，SGRQ評分小于對照組，6MWD大于對照組，急性加重頻率小于對照組，首次急性加重時(shí)間間隔大于對照組，差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）。阿奇霉素組的FEV1、FVC和FEV1/FVC均大于羅紅霉素組，IL-8、TNF-α和CRP小于羅紅霉素組，SGRQ評分小于羅紅霉素組，6MWD大于羅紅霉素組，急性發(fā)作率小于羅紅霉素組，急性加重間隔大于羅紅霉素組，差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療期間，3組不良反應(yīng)/不良事件發(fā)生率均無顯著性差異。結(jié)論 長期口服阿奇霉素對穩(wěn)定期COPD患者改善肺功能水平、降低氣道炎性因子、減少急性發(fā)作率均顯著優(yōu)于羅紅霉素，值得推廣。

Objective To comparative study clinical efficacy pulmonary function and inflammatory factor of oral azithromycin and roxithromycin in stable chronic obstructive pulmonary disease (COPD). Methods 150 patients with stable COPD were randomly divided into control group, roxithromycin group (300 mg/d) and azithromycin group (250 mg/d), all groups continuously treated for 6 months. Index of pulmonary function (including FEV1, FVC, FEV1/FVC)and inflammatory factor (including IL-8, TNF-α, CRP), Quality of Life (SGRQ score), sports tolerance (6MWD), acute exacerbation frequency and first acute exacerbation interval before and after treatment were compared between the three groups.Results 145 patients completed the trial, control group, azithromycin group and roxithromycin group respectively were 50, 48 and 47. Before treatment, three group of FEV1, FVC, FEV1/FVC, IL-8, TNF-α, CRP, SGRQ score and 6MWD all had no significant difference. After treatment, FEV1, FVC and FEV1/FVC of azithromycin group and roxithromycin group significantly higher than that of control group, IL-8, TNF-α and CRP lever lowe than that of control group, SGRQ score significantly lowe than that of control group, 6MWD significantly longer than that of control group, acute exacerbation frequency significantly lower than that of control group, first acute exacerbation interval significantly longer than that of control group, all of the difference had statistical significance (P<0.05). Meanwhile the FEV1, FVC and FEV1/FVC of azithromycin group significantly higher than that of roxithromycin group, IL-8, TNF- α and CRP significantly lower than that of roxithromycin group, SGRQ score significantly lowe than that of that of roxithromycin group, 6MWD significantly longer than that of roxithromycin group, the acute attack rate was less than that of roxithromycin, and the acute exacerbation interval was greater than that of roxithromycin. All of the difference had statistical significance (P<0.05). There was no significant difference in the incidence of adverse reactions/adverse events between three groups. Conclusion Long-term oral azithromycin is superior to roxithromycin in improvement of lung function, reduction of airway inflammatory factors, and reduction of acute exacerbation rate in patients with stable COPD.