Objective To determine the eifirary of clarithromycin in patients with refractory asthma and specifirally in a subgroup of patients with non-eosinophilic asthma. Methods Subjects with refractory asthma (n=45) were randomized to receive clarithromycin ( 500 mg twice daily ) or placebo for 8 weeks. Results Clarithromycin therapy significantly reduced airway concentrations of IL-8 and neutiophil numbers and improved quality-of-liie scores compared with placebo. Reductions in neutiophil elastase and MMP-9 concentra tions were also observed. These reductions in inflammation were most marked in those with refractory NEA. Conclusions; Clarithromycin therapy can modulate IL-8 levels and neutiophil accumulation and activation in the airways of patients with refract017 asthma. It may be an important additional therapy that could be used to reduce noneosinophilic airway inflammation, particularly neutiophilic inflammation in asthma.%目的 探讨克拉霉素对于难治性哮喘患者,特别是对非嗜酸粒细胞型哮喘(NEA)亚组患者的疗效.方法 难治性哮喘患者(n=45)被随机分配至克拉霉素组(500 mg bid)和安慰剂组,共8周.结果 克拉霉素与安慰剂相比,明显降低了气道IL-8的浓度和中性粒细胞的数目,改善了生活质量评分.另外NE和MMP-9的浓度得到降低,这对于NEA患者最为显著.结论 克拉霉素可调节难治性哮喘患者气道内IL-8水平和中性粒细胞的聚集和活性,降低非嗜酸粒细胞性炎症反应,特别是中性粒细胞性炎症反应.
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