利奈唑胺联合乌司他丁治疗重症肺炎的临床疗效及其对血清皮质醇、高迁移率族蛋白B1水平的影响

Clinical Effect of Linezolid Combined with Ulinastatin on Severe Pneumonia and the Impact on Serum Levels of COR and HMGB1

目的分析利奈唑胺联合乌司他丁治疗重症肺炎的临床疗效及其对血清皮质醇(COR)、高迁移率族蛋白B1(HMGB1)水平的影响。方法选取2016年1月-2017年1月惠州市中心人民医院收治的重症肺炎患者120例,根据其就诊编号、采用随机数字表法分为对照组和观察组,每组60例。在常规对症治疗基础上,对照组患者给予利奈唑胺治疗,观察组患者给予利奈唑胺联合乌司他丁治疗;两组患者均连续治疗1周。比较两组患者临床疗效、细菌清除效果、炎性指标恢复正常时间,治疗前后肺功能指标〔包括用力肺活量(FVC)、第1秒用力呼气容积(FEV1)及第1秒用力呼气容积与用力肺活量比值(FEV1/FVC)〕、血清COR及HMGB1水平,并观察治疗期间两组患者不良反应发生情况。结果(1)观察组患者临床疗效优于对照组(P<0.05)。(2)观察组患者细菌清除效果优于对照组(P<0.05)。(3)观察组患者中性粒细胞分数、白细胞计数、降钙素原、超敏C反应蛋白恢复正常时间短于对照组(P<0.05)。(4)治疗前两组患者FVC、FEV1、FEV1/FVC比较,差异无统计学意义(P>0.05)。治疗后观察组患者FVC、FEV1、FEV1/FVC高于对照组(P<0.05)。(5)治疗前两组患者血清COR、HMGB1水平比较,差异无统计学意义(P>0.05);治疗后观察组患者血清COR、HMGB1水平低于对照组(P<0.05)。(6)治疗期间两组患者腹痛、腹泻、耳鸣发生率比较,差异无统计学意义(P>0.05)。结论利奈唑胺联合乌司他丁治疗重症肺炎患者的疗效确切,能有效提高细菌清除效果,缩短患者炎性指标恢复正常时间,改善患者肺功能并降低血清COR、HMGB1水平,且安全性较高。

Objective To analyze the clinical effect of linezolid combined with ulinastatin on severe pneumonia and the impact on serum levels of COR and HMGB1.Methods A total of 120 patients with severe pneumonia were selected in the Central People’s Hospital of Huizhou from January 2016 to January 2017,and they were divided into control group and observation group according to random number table method based on visiting sequence,with 60 cases in each group.Based on conventional symptomatic treatment,patients in control group were treated with linazolamide,while patients in observation group were treated with linazolamide combined with ulinastatin;both groups were continuously treated for 1 week.Clinical effect,bacterial clearance effect,recovery time of inflammatory markers,pre-and post-treatment index of pulmonary function(including FVC,FEV1 and FEV1/FVC),serum levels of COR and HMGB1 were compared between the two groups,and incidence of adverse reactions was observed during treatment.Results(1)Clinical effect in observation group was statistically significantly better than that in control group(P<0.05).(2)Bacterial clearance effect in observation group was statistically significantly better than that in control group(P<0.05).(3)Recovery time of neutrophil fraction,WBC,procalcitonin and hs-CRP in observation group was statistically significantly shorter than that in control group,respectively(P<0.05).(4)There was no statistically significant difference in FVC,FEV1 or FEV1/FVC between the two groups before treatment(P>0.05),while FVC,FEV1 and FEV1/FVC in observation group were statistically significantly higher than those in control group after treatment(P<0.05).(5) There was no statistically significant difference in serum level of COR or HMGB1 between the two groups before treatment(P>0.05),while serum levels of COR and HMGB1 in observation group were statistically significantly lower than those in control group after treatment(P<0.05).(6)There was no statistically significant difference in incidence of abdominal pain,diarrhea or tinnitus between the two groups during treatment(P>0.05).Conclusion Linazolamide combined with ulinastatin has certain clinical effect in treating severe pneumonia,which can effectively improve the bacterial clearance effect and pulmonary function,shorten the recovery time of inflammatory markers,reduce the serum levels of COR and HMGB1,with relatively high safety.