【摘要】 目的 探讨左氧氟沙星联合阿奇霉素治疗老年难治性呼吸道感染的疗效及安全性。 方法 选择2005年2月-2010年9月收治的高龄难治性呼吸道细菌感染患者68例，随机分为治疗组和对照组。治疗组34例，给予左氧氟沙星联合阿奇霉素；对照组34例，给予左氧氟沙星，两组总疗程皆为15 d。观察两组患者的临床疗效、细菌清除率和不良反应。 结果 治疗组的总有效率为64.71%，对照组总有效率为32.35%，两组差异有统计学意义（Plt;0.05） 。治疗组细菌清除率为76.19%，对照组细菌清除率为36.36%，两组差异有统计学意义（Plt;0.05） 。治疗组和对照组的不良反应发生率分别为5.88%和8.82%，差异无统计学意义（Pgt;0.05）。结论 左氧氟沙星联合阿奇霉素治疗老年难治性呼吸道感染疗效高， 能有效清除细菌， 不良反应较少， 值得临床推广应用。【Abstract】 Objective To evaluate the efficacy and safety of levofloxacin combined with azithromycin on refractory respiratory infections in elder patients. Methods A total of 68 elder patients with refractory respiratory infections in our hospital from February 2005 to September 2010 were randomly divided into two groups: treatment group (n=34) and control group (n=34). The patients in treatment group were treated with levofloxacin combined with azithromycin; while the patients in the control group were treated with levofloxacin alone. The total treatment periods of both groups were 15 days. The therapeutic efficacy, eradication rate of pathogens and the rate of aelverse reactions were observed. Results The therapeutic effect rate was 64.71% in the treatment group and 32.35% in the control group, and the difference between the two groups was statistically significant (Plt;0.05). The eradication rate of pathogens was 76.19% in the treatment group and 36.36% in the control group, and the difference was significant (Plt;0.05). The rate of the adverse reaction was 5.88% in the treatment group and 8.82% in the control group, and there were no significant differences between the two groups (Pgt;0.05). Conclusion Levofloxacin combined with Azithromycin is effective on refractory respiratory tract infection in elder patients, which can effectively remove the bacteria with few adverse reaction.
ObjectiveTo systemically review the efficacy and safety of moxifloxacin for mycoplasma pneumoniae. MethodsSuch databases as PubMed, The Cochrane library (Issue 4, 2014), ISI, CBM, CNKI, VIP and WanFang Data were searched from inception to April 2014 for randomized controlled trials (RCTs) concerning moxifloxacin for mycoplasma pneumoniae. Two reviewers screened literature according to the inclusion and exclusion criteria, extract data, and assess methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2 software. ResultsA total of 16 RCTs involving 1 401 patients were included. The results of meta-analysis showed that:compared with erythrocin or azithromycin, moxifloxacin had higher recovery rate (OR=2.35, 95%CI 1.76 to 3.15, P<0.000 01), higher bacterium negative rate (OR=3.74, 95%CI 1.76 to 7.96, P=0.000 6), and shorter fever clearance time (MD=-1.07, 95%CI -1.43 to -0.71, P<0.000 01); compared with azithromycin alone, moxifloxacin combined with azithromycin had higher recovery rate (OR=1.63, 95%CI 1.09 to 2.42, P=0.02), higher bacterium negative rate (OR=5.78, 95%CI 2.41 to 13.84, P<0.000 1), and shorter fever clearance time (MD=-0.99, 95%CI -1.52 to -0.47, P=0.000 2). In addition, there was a lower incidence of liver damage (OR=0.16, 95%CI 0.04 to 0.72, P=0.02) in patients who took moxifloxacin compared with erythromycin or azithromycin. No significant difference was found in the incidence of gastrointestinal adverse reaction between the two groups. ConclusionMoxifloxacin for mycoplasma pneumonia is more effective than macrolides (erythrocin or azithromycin) with a lower incidence of adverse reaction. Due to limited quantity and quality of the included studies, the above conclusion should be further verified by conducting more high quality, large scale, multicentre RCTs.
ObjectiveTo investigate the effect of azithromycin on chronic obstructive pulmonary disease (COPD) vascular remodeling and its possible mechanism.MethodsEighteen male SD rats were randomly divided into normal control group (group A), model group (group B) and azithromycin intervention group (group C). In group B and group C, the COPD model was established by passive smoking and intratracheal injection of lipopolysaccharide. On the fifteenth day, group C was intragastricly administrated with azithromycin (50 mg/kg) one hour prior to smoking, while group A and group B were given equal amount of normal saline. All the rats were killed 6 weeks later. Hematoxylin-eosin staining was used to observe lung tissue pathological changes and victoria blue + Van Gieson staining was used to observe the pulmonary artery morphology changes. The serum osteopontin (OPN) was determined with ELISA. The protein expression of OPN was measured with immunohistochemistry and OPN mRNA was detected by RT-PCR.ResultsCompared with group A, the degree of pulmonary vascular inflammation and pulmonary vascular remodeling in groups B and C was more serious, but these changes in group C were lighter than those in group B. The serum OPN content, lung tissue OPN protein and OPN mRNA expression in groups B and C were higher than those in group A, while these parameters in group C were lower than those in group B. The content of serum OPN, the expression of OPN protein and OPN mRNA in lung tissue were positively correlated with the degree of pulmonary vascular inflammation and vascular remodeling.ConclusionAzithromycin can alleviate the pulmonary vascular inflammation and pulmonary vascular remodeling in COPD rats, and its mechanism may be related to inhibiting the expression of OPN.