利奈唑胺治疗耐甲氧西林金黄色葡萄球菌肺炎的疗效和影响因素分析

Analysis of treatment effect of linezolid on MRSA pneumonia and relevant influencing factors

目的评价利奈唑胺治疗耐甲氧西林金黄色葡萄球菌肺炎的疗效,分析与疗效相关的影响因素。方法将2009年1月至2013年1月在我院接受利奈唑胺治疗的47例耐甲氧西林金黄色葡萄球菌肺炎患者根据疗效分为治疗有效组和治疗失败组。比较两组患者的性别、年龄、体重、炎症指标、APACHEⅡ评分、动脉血氧分压和基础疾病,进而通过二元逻辑回归分析找出影响疗效的因素。结果利奈唑胺的临床总有效率为72.3%。治疗失败组的PCT值和APACHEⅡ评分更高[分别为（1.38±0.67）mg/L对（0.91±0.32）mg/L,14.3±5.7对9.8±4.1,P=0.029和0.004）,动脉血氧分压更低[（66±10）mmHg对（72±8）mmHg,P=0.016]。PCT值、APACHEⅡ评分和脑血管病是影响利奈唑胺治疗耐甲氧西林金黄色葡萄球菌肺炎疗效的临床因素。PCT的OR值为2.02（P=0.034,95%CI 1.06-3.88）,APACHEⅡ的OR值为1.41（P=0.013,95%CI 1.17-1.85）,脑血管病的OR值为5.42（P=0.017,95%CI 1.69-42.4）。结论利奈唑胺治疗耐甲氧西林金黄色葡萄肺炎的疗效良好,而高PCT值、高APACHEⅡ评分和脑血管病是治疗失败的主要危险因素。

Objective To evaluate the treatment effect of linezolid on MRSA pneumonia,and then analyze the influencing factors relevant to this treatment effect. Methods The clinical records of 47 MRSA pneumonia patients treated with linezolid admitted to our hospital from January 2009 to January 2013 were reviewed. The patients were divided into two groups,success group and failure group. Age,gender,weight,inflammatory indicators,APACHE Ⅱ score,arterial oxygen partial pressure and underlying diseases were comparatively analyzed,and factors influencing the treatment effect were found by logistic regression analysis. Results The rate of treatment effect was 72. 3%. The PCT value and APACHEⅡ score were higher[（ 1. 38 ± 0. 67） mg/L vs.（ 0. 91 ± 0. 32） mg/L,P = 0. 029; 14. 3 ± 5. 7 vs. 9. 8 ± 4. 1,P =0. 014）,and the PaO2was lower [（ 66 ± 10） mmHg vs.（ 72 ± 8） mmHg,P = 0. 016]in the failure group. PCT,APACHE Ⅱ score and cerebral vascular disease were factors influencing treatment effect. The OR value for PCT was 2. 02（ P =0.034,95% CI 1.06 -3.88）,the OR value for APACHEⅡ was 1.41（ P =0.013,95% CI 1.17 -1.85）,and the OR value for cerebral vascular disease was 5. 42（ P = 0. 017,95% CI 1. 69 - 42. 4）. Conclusion Linezolid can effectively treat MRSA pneumonia. High PCT value,high APACHE Ⅱ score and cerebral vascular disease are major risk factors for treatment failure.