支气管扩张症的抗生素治疗_Chinese Journal of Respiratory and Critical Care Medicine

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朱砚萍 , 瞿介明

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Keywords：

支气管扩张症; 抗生素; 治疗

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支气管扩张症(简称支扩)是指由多种原因引起支气管壁肌肉和弹力支撑组织的破坏而引起的中等大小支气管的不正常扩张，是一种肺组织结构破坏性疾病，表现为反复呼吸道感染，大量脓痰，可出现咯血。支扩有许多相关因素及病因，总体来说，其发生可归结于以下两个因素：① 感染的持续刺激；②气道阻塞、支气管引流功能损害和防御功能的缺陷。两种因素可以同时存在，互为因果。支扩的病程一般呈进行性发展，其机制可用Cole[1] 在1984年提出的恶性循环(vicious circle)假说来解释，该假说认为感染或定植的细菌触发气道上皮的炎症反应，释放炎症介质和酶，持续的慢性炎症反应引起支气管壁和肺组织的损伤，破坏气道纤毛上皮的清洁功能，进一步加重感染和细菌定植，形成一个周而复始的恶性循环。因此，抗生素几乎是现阶段治疗支扩的主要药物之一。

Citation： 朱砚萍,瞿介明. 支气管扩张症的抗生素治疗. Chinese Journal of Respiratory and Critical Care Medicine, 2007, 6(3): 161-162. doi: Copy

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9.	Rayner CF，Tillotson G，Cole PJ，et al. Efficacy and safety of long-term ciprofloxacin in the management of severe bronchiectasis. J Antimicrob Chemother. 1994 Jul;34(1):149-56..
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1. Cole PJ.A new look at the pathogenesis，management of persistent bronchial sepsis：a ‘vicious circle’hypothesis and its logical therapeutic connotations.In：Davies RJ，editor.Strategies for the management of chronic bronchial sepsis.Oxford：Medicine Publishing Foundation，1984，1-20.
2. Barker AF. Bronchiectasis.N Engl J Med，2002，346.：1383-1393.
3. Pasteur MC, Helliwell SM, Houghton SJ,et al. An investigation into causative factors in patients with bronchiectasis .Am J Respir Crit Care Med，2000，162：1277-1284.
4. O’Donnell AE, Barker AF, Ilowite JS, et al. Treatment of idiopathic bronchiectasis with aerosolized recombinant human DNase I. rhDNase Study Group.Chest，1998，113：1329-1334.
5. Bilton D, Henig N, Morrissey B, et al. Addition of inhaled tobramycin to ciprofloxacin for acute exacerbations of Pseudomonas aeruginosa infection in adult bronchiectasis. Chest, 2006;130:1503-1510.
6. Wallace RJ，Glassroth J，Griffith DE，et al.Diagnosi and treatment of disease caused by nontuberculous mycobacteria.Am J Respir Crit Care Med，1997，156(Suppl)：1-25.
7. Stevens DA，Schwartz HJ，Lee JY，et al. A randomized trial of itraconazole in allergic bronchopulmonary aspergillosis.N Engl J Med，2000，342：756-762.
8. Tsang KW，Ho PI，Chan KN，et al. A pilot study of low-dose erythromycin in bronchiectasis.Eur Respir J. 1999;13:361-364.
9. Rayner CF，Tillotson G，Cole PJ，et al. Efficacy and safety of long-term ciprofloxacin in the management of severe bronchiectasis. J Antimicrob Chemother. 1994 Jul;34(1):149-56..
10. Stockley RA, Hill SL, Morrison HM. Effect of antibiotic treatment on sputum elastase in bronchiectatic outpatients in a stable clinical state.Thorax. 1984 Jun;39(6):414-9.
11. Hill SL，Burnett D，Hewetson KA，et al. The response of patients with purulent bronchiectasis to antibiotics for four months. Q J Med,1988;66:163-73.

Chinese Journal of Respiratory and Critical Care Medicine

支气管扩张症的抗生素治疗

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