喹诺酮类治疗肺炎克雷伯菌感染的疗效及血清炎性因子变化

Effect of quinolones on treatment of Klebsiella pneumoniae infection and changes of serum inflammatory factors

目的观察喹诺酮类抗菌药物治疗肺炎克雷伯菌感染的疗效及血清白细胞计数(WBC)、降钙素原(PCT)和炎性因子肿瘤坏死因子-α(TNF-α)、白介素-18(IL-18)水平的变化情况。方法选取2016年2月-2018年7月在儋州市人民医院就诊的98例由肺炎克雷伯菌感染的患者为研究对象,随机分为对照组和研究组,各49例。对照组给予头孢克肟片治疗,研究组给予盐酸莫西沙星片治疗。观察两组患者肺炎克雷伯菌分布情况;比较两组患者临床疗效及血清WBC、PCT和炎性因子TNF-α、IL-18水平变化情况。结果肺炎克雷伯菌主要分布为血液(36.73%)、痰液(21.43%)及下呼吸道(15.31%);对照组无效率40.82%,总有效率59.18%,研究组无效率4.08%,总有效率95.92%。与对照组比,治疗后研究组总有效率更高,差异有统计学意义(P<0.05);与治疗前相比,两组患者血清WBC、PCT、TNF-α、IL-18水平更低,差异有统计学意义(P<0.05),与对照组比,研究组血清WBC、PCT、TNF-α、IL-18水平更低,差异有统计学意义(P<0.05)。结论喹诺酮类药物治疗肺炎雷伯菌感染疗效优于常规头孢类药物治疗,治疗后患者血清WBC、PCT、TNF-α、IL-18逐渐降至正常水平,明显改善患者肺炎克雷伯菌的感染情况。

OBJECTIVE To observe the effect of quinolones on treatment of Klebsiella pneumoniae infection and the changes of levels of serum white blood cell(WBC) counts and procalcitonin(PCT) as well as the inflammatory factors tumor necrosis factor-α(TNF-α) and interleukin-18(IL-18). METHODS A total of 98 patients with K.pneumoniae infection who were treated in Danzhou People’s Hospital from Feb 2016 to Jul 2018 were recruited as the study objects and randomly divided into the control group and the study group, with 49 cases in each group. The control group was treated with cefixime tablets, while the study group was given moxifloxacin hydrochloride tablets. The distribution of the K.pneumoniae strains isolated from the two groups of patients was observed, and the clinical curative effect and levels of serum WBC and PCT as well as the inflammatory factors TNF-α and IL-18 were observed and compared between the two groups of patients. RESULTS Among the patients with K.pneumoniae infection, 36.73% had blood infection, 21.43% had sputum infection, and 15.31% had lower respiratory tract infection. The ineffective rate was 40.82% in the control group, 4.08% in the study group;the total effective rate was 59.18% in the control group, 95.92% in the study group;the total effective rate of the study group was significantly higher than that of the control group after the treatment(P<0.05). The levels of serum WBC, PCT, TNF-α and IL-18 of the two groups of patients were lower after the treatment than before the treatment(P<0.05);the levels of serum WBC, PCT, TNF-α and IL-18 of the study group were significantiy lower than those of the control group(P<0.05). CONCLUSION Quinolones can achieve better effect on treatment of the K.pneumoniae infection than the conventional cephalosporins, reduce the levels of serum WBC, PCT, TNF-α and IL-18 to the normal levels and remarkably improve the prognosis of the patients with K.pneumoiae infection.