万古霉素治疗新生儿MRSA败血症对患儿炎症指标的影响及临床效果

Effect of vancomycin on neonatal MRSA septicemia and its clinical effect in children

目的探讨万古霉素治疗新生儿败血症对患儿炎症指标的影响及临床效果。方法选取该院2010年1月至2017年1月收治的67例耐甲氧西林金黄色葡萄球菌(MRSA)感染致败血症患儿的临床资料进行回顾性研究,患儿在未明确为MRSA感染前采用头孢硫脒+哌拉西林/舒巴坦治疗,明确为MRSA感染后采用万古霉素进行治疗,对比万古霉素治疗前后患儿的免疫学、炎症指标,并评价临床效果,以及用药不良反应情况。结果经万古霉素治疗后,67例患儿的血清免疫球蛋白G(IgG)、自然杀伤细胞(NK细胞)活性较未经万古霉素治疗前均显著升高(P<0.05),治疗后患儿的免疫球蛋白M(IgM)水平较治疗前降低(P<0.05)。治疗后,67例患儿的血清白细胞介素(IL)-6、IL-8、IL-2、白细胞介素-2受体(sIL-2R)、C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、降钙素原(PCT)和白细胞(WBC)测定值较治疗前均显著降低(P<0.05)。经万古霉素治疗后的治疗总有效率为89.55%,明显高于未经万古霉素治疗前的58.21%(P<0.05)。万古霉素治疗前、后患儿的不良反应发生率分别为19.40%和23.88%,差异无统计学意义(P>0.05)。两组患儿治疗过程中出现的不良反应均不严重,采用对症处理或暂缓用药,症状缓解后继续治疗。结论万古霉素治疗MRSA感染致新生儿败血症能显著改善患儿免疫水平,减轻全身炎性反应程度,治疗效果较好。

Objective To investigate the effect of vancomycin on neonatal sepsis and its clinical effect.Methods The clinical data of 67 children with methicillin resistant Staphylococcus aureus（MRSA）infection and septicemia treated in the hospital from January 2010 to January 2017 were reviewed.The children were treated with ceftazidime＋piperacillin/sulbactam when they did not diagnosed with MRSA infection.The children were treated with vancomycin when they diagnosed with MRSA infection.The immunological and inflammatory indexes of children before and after vancomycin treatment were compared,and the clinical effects and adverse reactions were evaluated.Results After vancomycin treatment,the serum IgG and NK cell activities in 67 children were significantly higher than those before vancomycin treatment（P〈0.05）,the level of IgM in children was lower than that before treatment（P〈0.05）.After treatment,the serum levels of IL-6,IL-8,IL-2,sIL-2 R,CRP,TNF-α,PCT,WBC in 67 children were significantly lower than those before treatment（P〈0.05）.The total effective rate of vancomycin treatment was 89.55%,which was higher than that without vancomycin treatment（58.21%,P〈0.05）;the occurrence of adverse reactions before and after treatment with vancomycin were 19.40%and 23.88%,and the difference was not statistically significant（P〈0.05）;the children of two groups did not appear serious adverse reactions during treatment,they were treated by symptomatic treatment or respite medication,and continue treated after symptom relief.Conclusion Vancomycin in the treatment of neonatal septicemia caused by MRSA infection can significantly improve the immune level of children,reduce the degree of systemic inflammatory response,and the treatment effect is better.