莫西沙星序贯治疗老年人细菌性肺炎的临床研究

Clinical Study of Moxifloxacin Sequential Therapy in Elderly Patients with Bacterial Pneumonia

目的:探讨莫西沙星序贯治疗老年人细菌性肺炎对2代测序技术(NGS)阳性率与临床指标的影响。方法:回顾性分析莆田学院附属医院2020年1月至2022年1月期间接受治疗的98例细菌性肺炎老年患者,根据治疗用药方案分为A组与B组,各49例。A组患者采用头孢类药物序贯治疗,B组患者采用莫西沙星序贯治疗。比较两组患者治疗前后NGS阳性率,观察治疗前后两组患者各项临床指标的变化情况。结果:B组患者咳嗽、湿啰音消失时间与白细胞、体温复常时间均短于A组,差异具有统计学意义(P<0.05)。治疗后两组患者第1秒用力呼气量占用力肺活量比值(FEV1%)、最大呼气中段流量(MMEF)、最大通气量(MVV)均有不同程度提高,且治疗后B组患者FEV1%、MMEF、MVV均高于A组,差异具有统计学意义(P<0.05)。治疗后两组患者血清超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)水平均有不同程度下降,且治疗后B组患者血清hs-CRP、TNF-α、PCT水平均低于A组,差异具有统计学意义(P<0.05)。治疗后B组患者NGS阳性率为4.08%(2/39),低于A组的24.49%(12/39),差异具有统计学意义(P<0.05)。结论:与头孢类药物相比采用莫西沙星治疗老年人细菌性肺炎疗效更为理想,能够更为有效的杀灭致病菌。

Objective To investigate the effect of moxifloxacin sequential therapy on the positive rate of next-generation sequencing(NGS)and clinical indicators in elderly patients with bacterial pneumonia.Methods A total of 98 elderly patients with bacterial pneumonia treated in the Affiliated Hospital of Putian University from January 2020 to January 2022 were retrospectively analyzed.According to the treatment regimen,they were divided into group A and group B,with 49 cases in each group.Patients in group A were treated with cephalosporins,and patients in group B were treated with moxifloxacin.The positive rate of NGS before and after treatment were compared between the two groups,and the changes of clinical indicators before and after treatment were observed in the two groups.Results The disappearance time of cough and moist rales,the recovery time of white blood cells and body temperature in group B were shorter than those in group A,and the differences were statistically significant(P<0.05).After treatment,the forced expiratory volume in the first second/forced vital capacity(FEV1%),maximum mid-expiratory flow(MMEF)and maximum ventilatory volume(MVV)of the two groups were increased in different degrees,and FEV1%,MMEF and MVV of the group B were higher than those of the group A,and the differences were statistically significant(P<0.05).After treatment,the serum levels of hypersensitive C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α),and procalcitonin(PCT)in two groups decreased to varying degrees,and the serum levels of hs-CRP,TNF-αand PCT in group B were lower than those in the group A,and the differences were statistically significant(P<0.05).After treatment,the positive rate of NGS in group B was 4.08%(2/39),which was lower than 24.49%(12/39)in group B,and the difference was statistically significant(P<0.05).Conclusion Moxifloxacin is more effective than cephalosporins in the treatment of bacterial pneumonia in the elderly,and it can kill pathogenic bacteria more effectively.