作者：林燕美，赵磊，张旻，包婺平

单位：

200080上海市，上海交通大学医学院附属第一人民医院呼吸与危重症医学科

Units：

Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School ofMedicine, Shanghai 200080, China

关键词：

哮喘；肺疾病，慢性阻塞性；支气管扩张症；慢性气道疾病；阿奇霉素；免疫调节；综述

Keywords：

Asthma; Pulmonary disease, chronic obstructive; Bronchiectasis; Chronic airway disease; Azithromycin;Immunomodulation; Review

CLC：

R 563 R 562

DOI：

10.12114/j.issn.1008-5971.2023.00.257

Funds：

国家自然科学基金资助项目（81873402）；上海市2020年度“科技创新行动计划”医学创新研究专项项目（20Y11902400）；上海市第一人民医院院级临床研究创新团队项目（CTCCR-2019B02，CTCCR-2021B07）

摘要：

慢性气道疾病包括哮喘、慢性阻塞性肺疾病和支气管扩张等，其主要病理生理机制为气道上皮细胞屏障被破坏后诱发局部/全身的免疫反应，这些疾病的共同特点为病情频繁恶化、患者生活质量降低和过早死亡。阿奇霉素除具有抗菌作用外，还有广泛的免疫调节作用。小剂量阿奇霉素长期维持治疗可用于预防或减少多种慢性气道疾病的急性加重，然而其具体机制目前尚不明确。本文回顾了阿奇霉素在慢性气道疾病中的应用现状及其免疫调节作用机制，指出阿奇霉素可能通过促进巨噬细胞向M2表型极化、增强巨噬细胞吞噬能力、诱导中性粒细胞凋亡、促进中性粒细胞脱颗粒、抑制中性粒细胞氧化应激、抑制中性粒细胞胞外陷阱的形成、诱导树突细胞向不成熟树突细胞极化、抑制T淋巴细胞增殖活化、抑制淋巴细胞分泌细胞因子等而抑制慢性气道疾病的发生发展，这有助于进一步探讨阿奇霉素治疗慢性气道疾病的可行性及其临床推广。

Abstract：

Chronic airway diseases include asthma, chronic obstructive pulmonary disease and bronchiectasis. Themain pathophysiological mechanism of chronic airway diseases is the local/systemic immune response induced by the breakdownof the airway epithelial cell barrier. The common characteristics of these diseases are frequent deterioration of the disease,reduced quality of life of patients and premature death. Azithromycin has a wide range of immunomodulatory effects in additionto antibacterial effects. Long-term maintenance of low-dose azithromycin can be used to prevent or reduce acute exacerbationsof a variety of chronic airway diseases, but the specific mechanism is still unclear. This article reviews the application status ofazithromycin in chronic airway diseases and its immunomodulatory mechanism, and points out that azithromycin may inhibit theoccurrence and development of chronic airway diseases by promoting the polarization of macrophages towards M2 phenotype,enhancing the phagocytosis ability of macrophages, inducing neutrophil apoptosis, promoting neutrophil degranulation, inhibiting neutrophil oxidative stress, inhibiting the formation of neutrophil extracellular traps, inducing the polarization of dendritic cells toimmature dendritic cells, inhibiting the proliferation and activation of T lymphocytes, inhibiting lymphocyte secretion of cytokines,which is helpful to further explore the feasibility and clinical promotion of azithromycin in the treatment of chronic airway diseases.

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