摘要
目的 研究阿米卡星联合治疗哌拉西林钠/他唑巴坦钠治疗重症肺炎的疗效及对血清高迁移率族蛋白B1(HMGB1)、可溶性髓系细胞触发受体-1(sTREM-1)、微RNA(miR)-233的影响.方法 前瞻性选择2018年1月至2022年12月黄石市中心医院收治的重症肺炎患者100例,依据随机数字表法分为阿米卡星组与对照组,各50例.两组均行祛痰、补液、扩张支气管及营养支持等常规治疗.在常规治疗基础上,对照组行哌拉西林钠/他唑巴坦钠治疗,阿米卡星组在对照组基础上行阿米卡星治疗.治疗14 d后,观察两组临床疗效、临床症状指标(发热时间、痰液颜色改变时间、肺部炎症吸收时间、机械通气时间及细菌清除率),观察两组治疗前及治疗14 d后血清指标[HMGB1、sTREM-1、miR-233水平、血清肿瘤坏死因子-a(TNF-a)、白细胞介素(IL)-6、L-10]、肺功能指标[用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、功能残气量(FRC)、深吸气量(IC)]和不良反应情况.结果 治疗14 d后,阿米卡星组总有效率为94.00％,高于对照组(76.00％),差异有统计学意义(P＜0.05).治疗14 d后,阿米卡星组发热时间、痰液颜色改变时间、肺部炎症吸收时间、机械通气时间为(3.26±0.35)、(4.19±0.44)、(8.24±0.85)、(8.64±0.89)d,均短于对照组[(6.31±0.66)、(7.08±0.73)、(9.31±0.95)、(10.78±1.30)d],细菌清除率为(92.75±9.54)％,高于对照组[(76.29±7.93)％],差异均有统计学意义(P＜0.05).治疗14 d后,阿米卡星组血清HMGB1、sTREM-1、miR-233 水平为(112.08±13.96)μg/L、(42.84±4.50)ng/L、1.19±0.13,均低于对照组[(140.17±17.64)μg/L、(51.07±6.38)ng/L、(1.51±0.17)],差异均有统计学意义(P＜0.05).治疗14 d后,阿米卡星组的血清TNF-a、IL-6水平为(1.01±0.12)ng/mL、(22.65±2.49)pg/mL,均低于对照组[(1.32±0.16)ng/mL、(26.83±2.94)pg/mL],阿米卡星组的IL-10水平为(15.98±1.82)pg/mL,均高于对照组[(12.74±1.53)pg/mL],差异均有统计学意义(P＜0.05).治疗14 d 后,阿米卡星组 FVC、FEV1、IC 为(3.22±0.35)、(2.14±0.23)、(2.56±0.28)L,均大于对照组[(2.94±0.32)、(1.93±0.21)、(2.27±0.25)L],FRC 为(2.02±0.22)L,小于对照组[(2.35±0.26)L],差异均有统计学意义(P＜0.05).两组不良反应发生率比较,差异无统计学意义(16.00％vs.8.00％)(P＞0.05).结论 阿米卡星联合治疗哌拉西林钠/他唑巴坦钠治疗重症肺炎可有效清除致病菌,抑制炎症反应,缩短临床恢复时间,改善肺功能,降低血清HMGB1、sTREM-1、miR-233水平,疗效显著,安全性好.
Abstract
Objective To investigate the efficacy of amikacin combined with piperacillin sodium and tazobactam sodium in the treatment of severe pneumonia and their effects on serum high mobility group protein B1(HMGB1),soluble myeloid cell trigger receptor-1(sTREM-1)and microRNA(miR)-233.Methods A total of 100 severe pneumonia patients admitted to Huangshi Central Hospital from January 2018 to December 2022 were prospectively selected,and they were divided into the amikacin group and the control group according to the random number table method,50 cases in each group.Both groups received routine treatments such as expectorant,fluid replacement,bronchodilation,and nutri-tional support.On the basis of conventional treatment,the control group received treatment with piperacillin sodium and tazobactam sodium,and the amikacin group received amikacin treatment based on the control group.After 14 d of treatment,the clinical effect and clinical symptom indica-tors(fever time,sputum color change time,pulmonary inflammatory absorption time,mechanical ventilation time and bacterial clearance rate)of the two groups were observed;and the levels of serum indicators[HMGB1,sTREM-1 and miR-233,tumor necrosis factor-alpha(TNF-al-pha),interleukin(IL)-6,IL-10],and pulmonary function indicators[forced vital capacity(FVC),forced expiratory volume in the first sec-ond(FEV1),functional residual volume(FRC)and deep inspiratory volume(IC)]were observed before and after 14 days of treatment and the adverse reaction of the two groups were observed.Results After 14 d of treatment,the total effective rate of the amikacin group was 94.00％,which was higher than that in the control group(76.00％),the difference was statistically significant(P＜0.05).After 14 d of treatment,the duration of fever,sputum color change,lung inflammation absorption,and mechanical ventilation in the amikacin group were(3.26±0.35),(4.19±0.44),(8.24±0.85),and(8.64±0.89)d,respectively,which were shorter than those in the control group[(6.31±0.66),(7.08±0.73),(9.31±0.95)and(10.78±1.30)d],the bacterial clearance rate was(92.75±9.54)％,which was higher than that in the control group[(76.29±7.93)％],the differences were statistically significant(P＜0.05).After 14 d of treatment,the levels of serum HMGB1,sTREM-1,and miR-233 in the amikacin group were(112.08±13.96)μg/L,(42.84±4.50)ng/L,and 1.19±0.13,respec-tively,which were lower than those in the control group[(140.17±17.64)μg/L,(51.07±6.38)ng/L,and 1.51±0.17],the differences were statistically significant(P＜0.05).After 14 d of treatment,the levels of serum TNF-α and IL-6 in the amikacin group were(1.01±0.12)ng/mL and(22.65±2.49)pg/mL,respectively,which were lower than those in the control group[(1.32±0.16)ng/mL,(26.83±2.94)pg/mL],the level of IL-10 in the amikacin group was(15.98±1.82)pg/mL,which was higher than that in the control group[(12.74±1.53)pg/mL],the differences were statistically significant(P＜0.05).After 14 d of treatment,FVC,FEV1,and IC in the ami-kacin group were(3.22±0.35),(2.14±0.23),and(2.56±0.28)L,respectively,which were greater than those in the control group[(2.94±0.32),(1.93±0.21),and(2.27±0.25)L],FRC in the amikacin group was(2.02±0.22)L,which was less than that in the control group[(2.35±0.26)L],the differences were statistically significant(P＜0.05).There was no significant difference in the incidence of ad-verse reactions between the two groups(16.00％vs.8.00％)(P＞0.05).Conclusion Amikacin combined with piperacillin sodium and tazobactam sodium in the treatment of severe pneumonia can effectively eliminate pathogenic bacteria,inhibit inflammatory response,shorten clini-cal recovery time,improve lung function,and decreased serum HMGB1,sTREM-1 and miR-233 levels,with significant efficacy and safety.
基金项目
2023年湖北省自然科学基金(2023AFD020)
2023年黄石市中心医院科研立项项目(ZX2023Q06)
NETL
NSTL
万方数据