成人肺炎支原体感染并发心肌损害患者CRP、IL-6等炎症指标与心肌酶谱变化的研究

Changes of inflammatory factors like CRP and IL-6 and myocardial enzyme spectrum of Mycoplasma pneumoniae infection adults complicated with myocardial damage

目的探讨成人肺炎支原体感染(MPP)并发心肌损害患者C-反应蛋白(CRP)、白介素-6(IL-6)等炎症指标与心肌酶谱变化,以期为临床治疗提供依据。方法选取2014年1月-2015年12月医院收治MPP合并心肌损害患者52例,为A组,另选同期住院MPP患者50例,为B组,非MP感染肺炎患者50例,为C组;B组给予阿奇霉素及对症治疗,A组在B组基础上给予营养心肌治疗,C组给予头孢菌素药物治疗;于治疗前及治疗1疗程后进行心肌酶谱及炎症水平测定,观察三组治疗期间心肌酶谱、炎症水平变化及治疗期间不良反应、治疗结局。结果治疗后,A组心电图异常、心衰及休克患者发生率与B、C组对比,差异有统计学意义(P<0.05);剔除死亡患者,A组治疗后各项心肌酶谱指标、CRP、IL-6、肿瘤坏死因子ɑ(TNF-ɑ)水平均低于同组治疗前(P<0.05),高于B、C组同期(P<0.05),白介素-10(IL-10)高于同组治疗前(P<0.05),低于B、C组同期(P<0.05)。结论成人MPP并发心肌损害患者炎症指标及心肌酶谱水平均呈增高状态,且高于单纯MPP及普通肺部感染,随着有效治疗,可使其水平逐渐降低;如单纯肺部MPP患者治疗过程中,见心肌酶谱、炎症指标呈增高状态,应考虑合并心肌损害,给予及早干预,以降低预后不良风险。

OBJECTIVE To explore the changes of inflammatory factors such as C-reactive protein （CRP） and inter- leukin-6 （IL-6） and myocardial enzyme spectrum of Mycoplasrna pneumoniae infection adults complicated with myocardial damage so as to provide guidance for clinical treatment. METHODS A total of 52 M. pneumoniae infec- tion patients complicated with myocardial damage who were treated in hospitals from Jan 2014 to Dec 2015 were chosen as the group A, 50 patients with M. pneumoniae infection who were hospitalized during the same period were assigned as the group B, and 50 patients with non-M, pneumoniae pneumonia were set as the group B. The group B was given azithromyein and symptomatic treatment, the group A was given nutritional myocardial therapy based on the treatment of the group B, and the group C was treated with cephalosporins. The myocardial enzyme spectrums and levels of inflammatory factors were determined before the treatment and after the treatment for one course ; the changes of myocardial enzyme spectrums, levels of inflammatory factors, adverse reactions, and treat- ment outcomes were observed and compared among the three groups during the treatment. RESULTS There was significant difference in the incidence of abnormal electrocardiogram （ECG）, heart failure, or shock among the group A, B, and C after the treatment （P〈0. 05）. Excluding the dead patients, the levels of the myocardial en- zyme spectrum indexes, CRP, IL-6, and tumor necrosis factor α （TNF-α） of the group A were lower after the treatment than before the treatment （P〈0.05） and were higher than those of the group B and the group C during the same period （P〈0.05）. The interleukin-10 （IL-10） level of the group A was higher after the treatment than before the treatment （P〈0.05） and was lower than that of the group B and the group C during the same period （P〈0.05）. CONCLUSION The levels of inflammatory factors and myocardial enzyme spectrums show elevating state in the M. pneumoniae infection adults complicated with myocardial damage and are lower in the patients with single M. pneumoniae infection and,theipatients with common pulmonary infection, and the effective treatment may reduce the levels of the indexes. It is necessary to take the complication with myocardial damage into consideration when the levels of myocardial enzyme spectrum, inflammatory factors of the patients with single M. pneumoniae infection show elevating state during the treatment and take intervention measures as early as possible so as to re- duce the risk of adverse prognosis.