利奈唑胺治疗肺部MRSA感染效果及其对炎性指标、内皮功能等的影响

Effects of linezolide on the levels of TNF-α,IL-6,ET and NO in lung MRSA infection

目的观察利奈唑胺治疗肺部甲氧西林耐药金黄色葡萄球菌(MRSA)感染疗效及其对炎性指标、内皮功能等指标的影响,方法将2015年2月—2017年2月四川省自贡市第一人民医院呼吸科收治肺部MRSA感染患者96例作为研究对象,随机数字表法分为观察组48例和对照组48例。2组患者均常规治疗,对照组在此基础上给予注射用盐酸去甲万古霉素0.8 g,溶于5%葡萄糖注射液250 ml静脉滴注,2次/d;观察组另予利奈唑胺注射液0.6 g,溶于溶于5%葡萄糖注射液250 ml静脉滴注,2次/d。2组患者疗程均为14 d。比较2组患者临床疗效、炎性指标(TNF-α、IL-1β、IL-6、CRP、PCT)、内皮功能(ET、NO)及其他相关指标(Lac、WBC、NE)水平变化情况,并记录不良反应。结果观察组总有效率为93.8%高于对照组79.2%(X^2=4.360,P=0.037)。与治疗前比较,2组治疗后TNF-α、IL-1β、IL-6、CRP、PCT、ET、NO、Lac、WBC、NE均降低(P<0.05),且治疗后观察组TNF-α、IL-1β、IL-6、CRP、PCT、ET、NO、Lac明显低于对照组(t=3.859、4.033、5.836、3.769、2.976、3.768、8.138、3.469,P均<0.01,而WBC、NE无明显变化,差异无统计学意义(t=0.129、0.598,P=0.448、0.276)。2组患者治疗过程中发生血小板降低、血肌酐升高、胃肠道反应、转氨酶升高、听力降低、过敏、脱落性皮炎等不良反应率比较,差异无统计学意义(P>0.05)。结论利奈唑胺治疗肺部MRSA感染疗效确切,有效降低炎性反应,安全可靠,值得临床推广应用。

Objective To investigate the effects of linezolide on the levels of TNF-α, IL-6, ET and NO in lung MRSA infection. Methods Ninety - six cases of patients with lung MRSA infection were selected, who were treated in hospital from February 2015 to February 2017, and they were divided into the observation group （48 cases） and control group （48 cases）. The patients of two groups were all treated with conventional treatment. The patients of control group were treated with injection with tetancomycin hydrochloride （0.8 g dissolved in 250 ml 5% glucose injection for intravenous infusion, 2 times / d）, while the patients of observation group were treated with linezolidazole injection （0.6 g dissolved in 250 ml 5% glucose injection for intravenous infusion, 2 times / d）. The patients of two groups were all treated for 14 days in a row. The clinical efficacy, adverse reactions and changes of the TNF-α, IL-1β, IL-6, ET, CRP, PCT, NO, Lac, WBC, NE levels of two groups were compared. Results After the appropriate treatment, the patients of the observation group got a total effective rate of 93.8% , which was significantly better than the 79.2% of the control group （ χ^2 = 4. 360, P = 0. 037 ） ; The TNF-α, IL- 1β, IL-6, CRP, PCT level of the observation group were significantly lower than those of the control group （ t = 3. 859, t = 4. 033, t =5. 836, t =3. 769, t =2. 976, t =3. 768,t = 8. 138,t =3. 469,P =0. 000, P =0. 000, P =0. 000, P =0. 000, P = 0. 002,0. 000,0. 000,0. 001 ）;ET, NO level of the observation group were significantly lower than those of the control group （ t = 3. 768, t = 8.138, P = 0. 000, P = 0.000） ; Lac level of the observation group were significantly lower than those of the control group（ t = 3. 469, P = 0. 000） ; while WBC, NE showed no significant changes （ t = 01 129, t = 0. 598 ; P = 0. 448, P = 0. 276） ; There were thrombocytopenia, elevated serum creatinine, gastrointestinal reactions, increased levels of transaminases, decreased hearing, allergies, exfoliative dermatitis and other adverse reactions occurred in both two groups, but there were no statistically significant between the two groups （χ^2 = 2. 192,χ^2 = 2. 122,χ^2 = 1. 098 ,χ^2 =0. 723 ,χ^2 =2. 122,χ^2 = 2. 192,χ^2 = 0.443, P = 0. 139, P = 0. 145, P = 0. 295, P = 0. 395, P = 0. 145, P = 0. 139, P = 0. 506）. Conclusion Linezolizine is effective in the treatment of pulmonary MRSA infection, which can effectively reduce the inflammatory response, and it is also safe and reliable, which makes it worthy of clinical application.