替加环素联合头孢哌酮-舒巴坦钠对老年多重耐药鲍曼不动杆菌肺炎患者炎性因子及免疫功能的影响

The Effect of Tigecycline in Combination with Cefoperazone Sodium and Sulbactam Sodium on the Inflammatory Factors and Immunologic Function of Senile Patients with Multiresistant Acinetobacter Baumannii Pneumonia

目的探讨替加环素联合头孢哌酮-舒巴坦钠治疗对老年多重耐药鲍曼不动杆菌肺炎患者炎性因子及免疫功能的影响。方法选择2015年1月—2017年7月我院收治的老年多重耐药鲍曼不动杆菌肺炎患者64例,采用随机数字表法分为研究组(n=32)和对照组(n=32)。对照组采用头孢哌酮-舒巴坦钠3 g+0. 9%氯化钠溶液100 ml每8 h 1次静脉滴注;研究组在对照组基础上加用替加环素(首日100 mg+0. 9%氯化钠溶液250 ml静脉滴注,第2日改为50 mg+0. 9%氯化钠溶液100 ml静脉滴注,每日2次)。疗程均为14 d。观察两组临床疗效及治疗前后血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)和免疫球蛋白M(Ig M)、免疫球蛋白G(Ig G)、免疫球蛋白A(Ig A)变化情况。结果研究组总有效率为90. 62%高于对照组的68. 75%,差异有统计学意义(P <0. 05)。较治疗前,治疗后两组TNF-α、IL-6、PCT、hs-CRP水平均降低,Ig M、Ig G显著升高,Ig A显著降低,且治疗后研究组上述指标改善情况均优于对照组,差异均有统计学意义(P <0. 05或P <0. 01)。结论老年多重耐药鲍曼不动杆菌肺炎给予替加环素联合头孢哌酮-舒巴坦钠治疗可减轻机体炎性反应,增强免疫功能,从而获得较好疗效。

Objective To investigate the eftect of tigecycline in combination with cefoperazone sodium and sulbactam sodium on the itfflammato-7 factors and immunologic function of senile patients with multiresistant acineto- bacter baumannii （MRAB） pneumonia. Methods A total of 64 senile patients with MRAB pneumonia admitted to our hospital flom Janual7 2015 to July 2017 were selected and divided into experimental group （n = 32） and control group （n = 32） using the random number table method. Patients in control group were given 3g cefoperazone sodium and sulbactam sodium and 100 ml of 0.9% sodium chloride solution by intravenous infusion once evel7 8 h. On the basis of control group, the patients in experimental group were additionally given 100 mg tigecycline and 250 ml of 0.9% sodium chloride solution by intravenous infusion on the first day and 50 mg tigecycline and 100 ml of 0.9% sodium chloride solution on the second day, twice eve-7 d thereafter. The course of treatment in both groups was 14 d. The clinical efficacy and the changes of serum tumor necrosis factor-or （TNF-ot）, interleukin-6 （ IL-6）, pro- calcitonin （ PCT）, high-sensitivity C-reactive protein （hs-CRP） and immunoglobulin M （ IgM）, immunoglobulin G （IgG） and immunoglobulin A （IgA） before and after treatment in the two groups were observed. Results The total eftective rate in experimental group was 90.62% , which was higher than that （68.75%） in control group, and the difterence was statistically significant （ P 〈 0.05 ）. Compared with those before treatment, the levels of TNF-a, IL-6, PCT and hs-CRP in both groups were decreased after treatment, as accompanied with significantly increased levels of IgM and IgG and remarkably reduced level of IgA. In addition, the improved conditions of the above indexes in experimental group after treatment were better than those in control group, and there were significant difterences （ P 〈 0.05 or P 〈 0.01 ）. Conclusion In the treatment of senile patients with MRAB pneumonia, tigecycline in combination with cefoperazone sodium and sulbactam sodium can reduce the inflammatory response and enhance the immunologic function, thus achieving a good cmative eftect.