目的 观察小剂量阿奇霉素对重症慢性阻塞性肺疾病（COPD）患者肺功能、支气管壁厚度的影响及整体疗效，并分析重症COPD的危险因素。方法 回顾性选取四川大学华西医院2020年5月—2022年6月收治的182例重症COPD患者为研究对象，根据治疗方法不同将患者分为对照组（n＝92）和试验组（n＝90），对照组患者给予噻托溴铵吸入粉雾剂吸入（每次18 μg，每天1次）及孟鲁司特钠咀嚼片口服（每片5 mg，每次2片，每天1次）治疗；试验组患者在对照组治疗基础上加用小剂量阿奇霉素分散片（每片 0.25 g，每次 125 mg，每天 1次），两组治疗均 4周为 1个疗程，连续治疗 6个疗程。比较两组总有效率，比较两组患者治疗前后血清炎性因子［血清单核细胞趋化蛋白-1（MCP-1）、血清淀粉样蛋白（SAA）、可溶性髓样细胞触发受体-1（sTREM-1）］、肺功能［第1秒用力呼气量（FEV1）、用力肺活量（FVC）、FEV1占FVC的百分比（FEV1/FVC）］及支气管壁厚度［气道壁厚度（T）、管壁内径与外径比值（T/D）、管壁面积占气道总截面的百分比（WA%）］水平；分析重症 COPD 患者肺功能与支气管壁厚度基线水平的相关性；单因素分析重症 COPD 和轻、中症COPD患者的临床特征；二元Logistic方程分析重症COPD的影响因素；Spearman相关系数分析重症COPD发生率与危险因素的相关性。结果 试验组患者治疗总有效率（90.00%）明显高于对照组（69.57%，P＜0.05）；治疗后，两组患者血清炎症因子 MCP-1、SAA、sTREM-1 水平均较同组治疗前显著降低（P＜0.05），且试验组患者血清 MCP-1、SAA 和sTREM-1 水平显著低于对照组（P＜0.05）。治疗后，试验组患者 FEV1、FVC、FEV1/FVC 水平均显著高于同组治疗前水平（P＜0.05），且显著高于对照组治疗后水平（P＜0.05）；对照组治疗前后肺功能指标水平无显著变化（P＞0.05）。治疗后，两组患者 T/D、WA%水平均较同组治疗前显著降低（P＜0.05），且试验组患者 T/D、WA%水平明显低于对照组（P＜0.05）。重症 COPD 患者 T/D、WA%与 FEV1、FVC、FEV1/FVC 均呈负相关（P＜0.001）；患者年龄、文化程度、吸烟史、无创正压机械通气及FEV1分级为重症COPD患者的影响因素，且年龄、吸烟史及FEV1均与重症COPD呈正相关，文化程度及无创正压机械通气均与重症 COPD 呈负相关。结论 对于重症 COPD 患者而言，小剂量阿奇霉素可有效提升其临床疗效，改善患者肺功能指标，降低患者炎性因子和支气管壁厚度；患者年龄、文化程度、吸烟史、无创正压机械通气及FEV1均与COPD患者病情有一定相关性，临床诊治COPD患者可参考影响因素制定积极的治疗方案。

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

四川省科技计划项目—重点研发项目（2022YFS0262）