目的 观察阿奇霉素对支气管扩张患者的临床疗效和安全性，并探讨了其可能的抗炎机制。方法 收集张家港市中医医院呼吸内科2015年2月-2016年2月收治的支气管扩张症患者94例，使用数字表法将96例患者随机分为对照组和观察组，每组47例。对照组给予吸氧、止咳、化痰、等常规治疗，体位引流、震动拍击、主动呼吸训练，吸气肌训练等物理治疗促进排痰；观察组在对照组基础上给予阿奇霉素250 mg/次，1次/d，疗程12个月。ELISA法检测p65和IL-6，比较两组治疗前、后的呼吸困难量表（mMRC）评分、肺功能、痰液量、痰液密度和性状评分及不良反应。结果 治疗后对照组p65和IL-6表达较治疗前无显著性变化，但观察组p65和IL-6表达较治疗前显著减低，同组治疗前后比较差异有统计学意义（P<0.05）。对照组呼吸困难评分治疗后显著减低，同组治疗前后比较差异有统计学意义（P<0.05），FEV1/FVC和FVE1/pred治疗后变化无统计学意义；观察组呼吸困难评分治疗显著减低，FEV1/FVC和FVE1/pred治疗后显著升高，同组治疗前后比较差异有统计学意义（P<0.05）。治疗后观察组痰液密度评分、痰液性状评分和痰液量均显著低于对照组，差异有统计学意义（P<0.05）。观察组不良反应发生率为10.6%（5/47），对照组为8.5%（4/47），两组间无显著性差异。结论 阿奇霉素长期治疗支气管扩张可以显著改善肺功能，使用安全，抑制NF-κB通路，可能是其减轻气道炎症反应的主要机制。

Objective To detect the clinical efficacy azithromycin on patients with bronchiectasis and explore its mechanism.Methods A total of 94 patients with bronchiectasis were enrolled in this study. The patients were randomly divided into observation group and control group, 47 cases in each group. The expression of p65, hs-CRP, and IL-6 was detected by ELISA analysis. The pulmonary function index and adverse reaction were compared between the two groups.Results There was no difference of p65 and IL-6 between before and after treatment in control groups. After treatment, p65, hs-CRP, and IL-6 was lower in observation group than that in control group (P< 0.05). After treatment, dyspnea score was lower in observation group than that in control group (P< 0.05), and FEV1/FVC and FVE1/pred was higher in observation group than that in control group (P< 0.05). After treatment, sputum density score, sputum character score, sputum volume was lower in observation group than that in control group (P< 0.05). The rate of adverse reaction was 10.6% (5/47) in observation group and 8.5% (4/47) in control group. There was no difference between the two groups.Conclusion Long term treatment of bronchiectasis with azithromycin can improve pulmonary function, inhibit NF-kB pathway to reduce airway inflammatory response, and with significant safety.