目的 觀察小劑量阿奇霉素對重癥慢性阻塞性肺疾?。–OPD）患者肺功能、支氣管壁厚度的影響及整體療效，并分析重癥COPD的危險因素。方法 回顧性選取四川大學(xué)華西醫(yī)院2020年5月—2022年6月收治的182例重癥COPD患者為研究對象，根據(jù)治療方法不同將患者分為對照組（n＝92）和試驗組（n＝90），對照組患者給予噻托溴銨吸入粉霧劑吸入（每次18 μg，每天1次）及孟魯司特鈉咀嚼片口服（每片5 mg，每次2片，每天1次）治療；試驗組患者在對照組治療基礎(chǔ)上加用小劑量阿奇霉素分散片（每片 0.25 g，每次 125 mg，每天 1次），兩組治療均 4周為 1個療程，連續(xù)治療 6個療程。比較兩組總有效率，比較兩組患者治療前后血清炎性因子［血清單核細(xì)胞趨化蛋白-1（MCP-1）、血清淀粉樣蛋白（SAA）、可溶性髓樣細(xì)胞觸發(fā)受體-1（sTREM-1）］、肺功能［第1秒用力呼氣量（FEV1）、用力肺活量（FVC）、FEV1占FVC的百分比（FEV1/FVC）］及支氣管壁厚度［氣道壁厚度（T）、管壁內(nèi)徑與外徑比值（T/D）、管壁面積占?xì)獾揽偨孛娴陌俜直龋╓A%）］水平；分析重癥 COPD 患者肺功能與支氣管壁厚度基線水平的相關(guān)性；單因素分析重癥 COPD 和輕、中癥COPD患者的臨床特征；二元Logistic方程分析重癥COPD的影響因素；Spearman相關(guān)系數(shù)分析重癥COPD發(fā)生率與危險因素的相關(guān)性。結(jié)果 試驗組患者治療總有效率（90.00%）明顯高于對照組（69.57%，P＜0.05）；治療后，兩組患者血清炎癥因子 MCP-1、SAA、sTREM-1 水平均較同組治療前顯著降低（P＜0.05），且試驗組患者血清 MCP-1、SAA 和sTREM-1 水平顯著低于對照組（P＜0.05）。治療后，試驗組患者 FEV1、FVC、FEV1/FVC 水平均顯著高于同組治療前水平（P＜0.05），且顯著高于對照組治療后水平（P＜0.05）；對照組治療前后肺功能指標(biāo)水平無顯著變化（P＞0.05）。治療后，兩組患者 T/D、WA%水平均較同組治療前顯著降低（P＜0.05），且試驗組患者 T/D、WA%水平明顯低于對照組（P＜0.05）。重癥 COPD 患者 T/D、WA%與 FEV1、FVC、FEV1/FVC 均呈負(fù)相關(guān)（P＜0.001）；患者年齡、文化程度、吸煙史、無創(chuàng)正壓機械通氣及FEV1分級為重癥COPD患者的影響因素，且年齡、吸煙史及FEV1均與重癥COPD呈正相關(guān)，文化程度及無創(chuàng)正壓機械通氣均與重癥 COPD 呈負(fù)相關(guān)。結(jié)論 對于重癥 COPD 患者而言，小劑量阿奇霉素可有效提升其臨床療效，改善患者肺功能指標(biāo)，降低患者炎性因子和支氣管壁厚度；患者年齡、文化程度、吸煙史、無創(chuàng)正壓機械通氣及FEV1均與COPD患者病情有一定相關(guān)性，臨床診治COPD患者可參考影響因素制定積極的治療方案。

Objective To observe the effects of low-dose azithromycin on lung function, bronchial wall thickness, and overall efficacy in patients with severe chronic obstructive pulmonary disease (COPD), and to analyze the risk factors of severe COPD.Method A retrospective study was conducted on 182 patients with severe COPD admitted to West China Hospital of Sichuan University from May 2020 to June 2022. According to different treatment methods, the patients were divided into control group (n = 92) and experimental group (n = 90). Patients in the control group were received inhalation of Tiotropium Bromide Powder Spray (18 μg per time, once a day) and oral administration of Montelukast Sodium Chewable Tablets (5 mg per tablet, two tablets per time, once a day) for treatment. Patients in the experimental group were treated with low-dose Azithromycin Dispersible Tablets (0.25 g per tablet, 125 mg per dose, once a day) in addition to the control group. Both groups were treated for four weeks as a course of treatment, with six consecutive courses of treatment. Compare the total effective rates of the two groups, and compare the serum inflammatory factors [serum monocyte chemoattractant protein-1 (MCP-1), serum amyloid protein (SAA), soluble myeloid cell triggering receptor-1 (sTREM-1)], lung function [forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), percentage of FEV1 to FVC (FEV1/FVC)] and bronchial wall thickness [airway wall thickness (T), ratio of inner diameter to outer diameter (T/D), percentage of wall area to total airway section (WA% )]before and after treatment between the two groups of patients. The correlation between lung function and baseline bronchial wall thickness in severe COPD patients was analyzed. Single factor analysis of the clinical characteristics of patients with severe COPD and mild to moderate COPD was analyzed. Influencing factors of severe COPD was analyzed using binary Logistic equation. Spearman correlation coefficient analysis of the correlation between the incidence of severe COPD and risk factors was analyzed.Results The total effective rate of treatment in the experimental group (90.00%) was significantly higher than that in the control group (69.57%, P < 0.05). After treatment, the levels of serum inflammatory factors MCP-1, SAA, and sTREM-1 in both groups of patients were significantly reduced compared to the same group before treatment (P < 0.05), and the levels of serum MCP-1, SAA, and sTREM-1 in the experimental group were significantly lower than those in the control group (P < 0.05). After treatment, the levels of FEV1, FVC, and FEV1/FVC in the experimental group were significantly higher than those in the same group before treatment (P < 0.05), and significantly higher than those in the control group after treatment (P < 0.05). There was no significant change in lung function indicators before and after treatment in the control group (P > 0.05). After treatment, the T/D and WA% levels in both groups of patients were significantly lower than before treatment (P < 0.05), and the T/D and WA% levels in the experimental group were significantly lower than those in the control group (P < 0.05). The T/D and WA% of severe COPD patients were negatively correlated with FEV1, FVC, and FEV1/ FVC (P < 0.001). Age, education level, smoking history, non-invasive positive pressure mechanical ventilation, and FEV1 grading of patients are influencing factors for severe COPD. Age, smoking history, and FEV1 grading are positively correlated with severe COPD, and education level and non-invasive positive pressure mechanical ventilation are negatively correlated with severe COPD.Conclusion For severe COPD patients, low-dose azithromycin can effectively improve their clinical efficacy, improve lung function indicators, reduce inflammatory factors and bronchial wall thickness. The age, educational level, smoking history, non-invasive positive pressure mechanical ventilation, and FEV1 grading of patients with COPD are all related to their condition. Clinical diagnosis and treatment of COPD patients can refer to influencing factors to develop active treatment plans.

R974

四川省科技計劃項目—重點研發(fā)項目（2022YFS0262）