莫西沙星对老年人肺部感染的疗效及安全性

Efficacy and safety of moxifloxacin in treatment of elderly inpatients with pulmonary infection

目的：评价莫西沙星注射液对老年肺部感染病人的疗效及安全性。方法：2013年1月至2014年12月期间入住第二军医大学长海医院急诊科的18-49岁（成年组）和≥65岁（老年组）的院外肺部感染病人各40例。肺部感染的严重程度用CURB-65评分和PSI评分来评价。两组病人均静脉给予盐酸莫西沙星氯化钠注射液0.4g,90min恒速滴注完毕,qd。分别于治疗后第1、3、5、7天晨7：00取静脉血备检。用HPLC法测血药浓度,常规方法测定肝、肾功能,凝血功能,血、尿常规等。结果：经CURB-65评分和PSI评分评价,老年组肺部感染较成年组严重（P〈0.05）。莫西沙星治疗7d后,两组病人的体温、白细胞计数、降钙素原、C反应蛋白均降至正常范围。PaO_2明显升高,PaCO_2明显降低。D-二聚体水平较治疗前明显降低（P〈0.05）。影像学结果示,老年组病人治疗总有效率低于成年组[38例（95.0%）vs 40例（100.0%）,P=0.023]。两组病人的血红蛋白、血小板、凝血酶原时间、血清肌酐、血糖、丙氨酸氨基转移酶（alanine aminotransferase,ALT）、天冬氨酸氨基转移酶（aspartate transaminase,AST）、碱性磷酸酶（alkaline phosphatase,ALP）较治疗前无明显变化。每个检测时间点,老年组莫西沙星血药浓度均高于成年组（P〈0.05）。结论：莫西沙星对老年人肺部感染有效,治疗期间未对血液系统,肝、肾功能产生不良影响,但相对于成年人,老年人体内药物积蓄现象较为明显。

Objective：To evaluate the efficacy and safety of moxifloxacin in treatment of elderly inpatients with pulmonary infection.Methods：Patients with community-acquired pulmonary infection,who were aged between 18-49 years or≥65years,were enrolled from Jan 2013 to Dec 2014 and divided into the senile group and the adult group,each consisting of 40 patients.Pneumonia severity was evaluated by CURB-65 and PSI scores.All patients were treated with moxifloxacin injection at a dosage of 0.4g,ivgtt,qd.The injection was completed within 90 minutes.Blood samples were collected at 7：00am on the days of 1,3,5and 7after treatment.HPLC method was used to determine plasma concentration of moxifloxacin.Liver and kidney functions,coagulation function,blood routine and urinary routine were also determined.Results：Pulmonary infection was significantly severer in the senile group（CURB-65 and PSI score）.After 7days of moxifloxacin treatment,temperature,white cell count,procalcitonin and C-reactive protein were evidently improved and recovered to normal in the patients of both groups.PaO2 increased and PaCO2 decreased significantly.D-dimer level was much lower,as compared with the baseline（P〈0.05）.According to imaging examination,the overall effective rate was significantly higher in the adult group[40cases（100.0%）vs38cases（95.0%）,P=0.023].Hemoglobin level,platelet,prothrombin time,creatinine,blood glucose,ALT,AST,ALP showed no significant differences as compared with the baseline levels.For all the time points tested,the patients of the senile group had a higher plasma concentration of moxifloxacin as compared with those of the adult group（P〈0.05）.Conclusion：According to the study,moxifloxacin was effective for senile pulmonary infection without significant adverse effects on the hematologic system,and liver,kidney functions.But the senile population showed a higher tendency of drug accumulation,as compared with the adults.