替考拉宁与去甲万古霉素治疗革兰阳性菌重症肺炎患者的临床疗效

Clinical efficacy of teicoplanin and norvancomycin in treatment of gram-positive bacteria in patients with severe pneumonia

目的探讨替考拉宁与去甲万古霉素治疗革兰阳性菌重症肺炎患者的临床疗效。方法选择2016年9月-2018年9月河南省南阳市中心医院收治的74例被确诊的革兰阳性菌重症肺炎患者,采用简单随机抽样法将患者分为替考拉宁组和去甲万古霉素组,各37例。分别采用替考拉宁治疗和去甲万古霉素治疗,两组均连续治疗14 d。分别于治疗前后,采用痰培养检测病原菌的分布和清除情况;血常规分析仪检测白细胞(WBC)数量;ELISA法检测血清肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)和降钙素原(PCT)水平。治疗后,对两组患者进行临床疗效和微生物疗效判定,记录不良反应发生情况。结果治疗前,重症肺炎患者的病原菌以金黄色葡萄球菌为主(44.59%),其次为凝固酶阴性葡萄球菌(29.73%);替考拉宁组治疗的总有效率为86.49%,病原菌清除率为83.78%,去甲万古霉素组治疗的总有效率为75.68%,病原菌清除率为72.97%,两组治疗的有效率和病原菌清除率差异无统计学意义;治疗后替考拉宁组患者血清WBC、TNF-α、CRP和PCT水平分别为(9.54±2.07)×10~9/L、(176.22±38.59)ng/L、(47.95±7.14)mg/L和(3.94±0.89)μg/L均低于去甲万古霉素组(P<0.001);替考拉宁组的不良反应发生率为8.11%低于去甲万古霉素组的27.03%(P=0.032)。结论替考拉宁与去甲万古霉素均可有效清除革兰阳性菌重症肺炎患者的病原菌,两者疗效相当,但替考拉宁治疗的不良反应低于去甲万古霉素。

OBJECTIVE To explore the clinical efficacy of teicoplanin and norvancomycin in the treatment of Gram-positivebacteria in patients with severe pneumonia.METHODS A total of 74 patients diagnosed with Gram-positive bacteria admitted to Nanyang Central Hospital in Henan Province from Sep.2016 to Sep.2018 were selected and the patients were divided into teicoplanin group and norvancomycin group by simple random sampling,with 37 cases in each group.The teicoplanin group was treated with teicoplanin and norvancomycin group was treated with norvancomycin.Both groups were continuously treated for 14 days.Before and after treatment,distribution and clearance conditions of pathogens were detected by sputum culture,the number of white blood cells(WBC)was detected by blood routine analyzer,the levels of serum tumor necrosis factor-α(TNF-α)and C-reactive protein(CRP)were detected by ELISA.Immunochromatography was performed to detect level of procalcitonin(PCT).After treatment,the clinical efficacy and microbial efficacy in the two groups were determined.The occurrence of adverse reactions was recorded.RESULTS Prior to treatment,the major pathogens in patients with severe pneumonia were Staphylococcus aureus(44.59%),followed by Coagulase negative Staphylococcus(29.73%).The total effective rate of treatment in teicoplanin group was 86.49%and the pathogen clearance rate was 83.78%,respectively.The total effective rate of treatment in norvancomycin group was 75.68%and the pathogen clearance rate was 72.97%,respectively.There was no significant difference in effective rate of treatment and pathogen clearance rate between the two groups.After treatment,levels of serum WBC,TNF-α,CRP and PCT in teicoplanin group were(9.54±2.07)×10~9/L、(176.22±38.59)ng/L、(47.95±7.14)mg/L、(3.94±0.89)μg/L significantly lower than those in norvancomycin group(P<0.001).The incidence of adverse reactions in teicoplanin group was significantly lower than that in norvancomycin group(8.11%vs 27.03%)(P=0.032).CONCLUSION Both teicolanin and deicolancomycin could effectively remove the pathogenic bacteria in patients with gram-positive coccal severe pneumonia,and the efficacy was similar,however,the adverse reactions of teicoplanin was significantly lower than that of norvancomycin.