利奈唑胺对MRSA肺炎患者血清CRP与TNF-α水平影响及其疗效分析

Analysis on the Effect of Linezolid on MRSA Pneumonia Patients Serum CRP and TNF-α Levels and its Curative Effect

目的:探讨利奈唑胺对耐甲氧西林金黄色葡萄球菌(MRSA)肺炎患者血清CRP与TNF-α水平的影响,并分析其临床疗效。方法:选取2013年4月至2015年3月我院入院治疗的62例MRSA肺炎患者,根据治疗药物的不同分成两组,其中试验组32例(利奈唑胺治疗),对照组30例(万古霉素治疗),比较两组患者治疗前后血清CRP与TNF-α水平变化情况,并观察其疗效及不良反应的发生情况,同时对试验组32例患者体内分离得到的32株MRSA进行体外耐药诱导实验,观察其耐药性变化情况。结果:试验组的治疗有效率(87.5%)显著优于对照组的治疗有效率(60.0%),P<0.05;两组患者在治疗后,血清CRP与TNF-α水平均显著降低(P<0.05),且试验组血清CRP与TNF-α水平下降幅度显著大于对照组(P<0.05),同时通过检测血清CRP与TNF-α水平变化情况能够灵敏地判断出患者治疗是否有效,其灵敏度为93.5%(58/62);试验组治疗后患者病原菌的清除率(78.1%)显著高于对照组病原菌清除率(50.0%),P<0.05;同时试验组与对照组不良反应发生率差异不显著(P>0.05),分别为12.5%与16.7%;经过21次体外诱导,利奈唑胺对MRSA的最低抑菌浓度(MIC)变化不大,耐药性最强者升高8倍,MIC值为4 mg·L-1。结论:利奈唑胺能够显著降低MRSA肺炎患者血清CRP及TNF-α水平,其疗效显著,安全可靠,且通过检测血清CRP及TNF-α水平变化能够灵敏地判断出药物疗效,同时利奈唑胺难以诱导MRSA对其产生耐药性,是一种具有优良特性的噁唑烷酮类抗生素,值得在临床上推广使用。

Objective： To investigate the effect of linezolid on serum CRP and TNF-α levels,and to analyze its clinical curative effect for MRSA pneumonia patients. Methods： 62 patients with MRSA pneumonia were divided into 2 groups,32 cases（ treated with linezolid） in the experimental group,and 30 cases（ treated with vancomycin） in the control group in our hospital from April 2013 to March2015. Serum CRP and TNF-α levels were compared between 2 groups before and after drug treatment,and the efficacy and adverse reaction of linezolid and vancomycin were observed. 32 strains of MRSA isolated from the experimental group were induced in vitro,and then the changes of the drug resistance were observed. Results： The effective rate in the experimental group（ 87. 5%） was significantly higher than the control group（ 60. 0%）,P 〈 0. 05. Serum CRP and TNF-α levels were significantly decreased in 2 groups after treatment,P 〈0. 05. And serum CRP and TNF-α levels in the experimental group were also significantly decreased than the control group,P 〈 0. 05.The therapeutic effects were evaluated by detecting the changes of serum CRP and TNF-α levels,and the sensitivity was 93. 5%（ 58 /62）. The bacterial clearance rate in the experimental group（ 78. 1%） was significantly higher than the control group（ 50. 0%） after treatment,P 〈 0. 05,but there was no significant difference of adverse reaction rate between 2 groups. The minimum inhibitory concentration（ MIC） of linezolid on MRSA changed little after 21 times induce in vitro,and the MIC value was 4 mg·L- 1. Conclusion： Linezolid could significantly reduce the serum CRP and TNF-α levels in MRSA pneumonia patients,and the therapeutic effects were evaluated by detecting the changes of serum CRP and TNF-α levels. Linezolid was safe and effective,and linezolid hardly induced MRSA resistant against drug. Linezolid should be worthy of promotion and application in clinical with excellent characteristics.