微生态制剂联合莫西沙星序贯疗法对老年慢性阻塞性肺疾病合并下呼吸道感染患者肠道菌群及免疫功能的影响

Effect of microecologics combined with Moxifloxacin sequential therapy on intestinal microecology and immune function in elderly patients with COPD combined with lower respiratory tract infection

目的探究微生态制剂联合莫西沙星序贯疗法对老年慢性阻塞性肺疾病(COPD)合并下呼吸道感染患者肠道菌群及免疫功能的影响。方法选取2016年2月到2019年2月我院收治的98例老年COPD合并下呼吸道感染患者为研究对象,按照随机数字表法分为观察组和对照组各49例。对照组患者采用莫西沙星序贯法进行治疗。观察组患者采用微生态制剂联合莫西沙星治疗。检测两组患者下呼吸道感染病原菌及肠道微生物变化,T淋巴细胞亚群(CD4+细胞,CD8+细胞,CD4+/CD8+)水平,并评价患者临床效果和并发症情况。结果治疗后两组患者CAT评分(8.23±3.64、10.41±4.08)和mMRC评分(1.35±0.82、1.77±0.61)均低于治疗前(23.01±4.47、22.87±5.26、2.79±0.54、3.04±0.74),且观察组下降幅度大于对照组,差异具有统计学意义(均P<0.05)。治疗后两组患者下呼吸道感染主要病原菌中肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、肺炎链球菌检出率均低于治疗前,但组间比较差异无统计学意义(均P>0.05)。治疗后两组患者肠道双歧杆菌、嗜酸乳杆菌、粪肠球菌数量均高于治疗前,大肠埃希菌数量均低于治疗前,且观察组改善情况优于对照组,差异有统计学意义(均P<0.05)。治疗后两组患者CD4+细胞、CD4+/CD8+均高于治疗前,且观察组高于对照组,差异有统计学意义(均P<0.05)。CD8+细胞数量治疗前后及组间比较差异无统计学意义(均P>0.05)。治疗后观察组患者腹胀(18.4%)、胃潴留(20.4%)发生率均低于对照组(36.7%、38.8%),差异有统计学意义(均P<0.05)。两组患者应激性溃疡发生率(20.4%、24.5%)差异无统计学意义(P>0.05)。结论微生态制剂联合莫西沙星序贯疗法治疗老年COPD合并下呼吸道感染能促进患者肠道微生态平衡,调节免疫功能,进而改善患者病情。

Objective To observe the effects of microecologics combined with Moxifloxacin sequential therapy on intestinal flora and immune function in elderly patients with chronic obstructive pulmonary disease(COPD)combined with lower respiratory tract infection(LRTI).Methods A total of 98 elderly patients with COPD and LRTI admitted to our hospital from February 2016 to February 2019 were enrolled and were randomly divided into the observation group(n=49,microecologics combined with Moxifloxacin sequential therapy)or the control group(n=49,Moxifloxacin sequential therapy).The pathogens of LRTI,intestinal microbial changes and levels of T cell subsets(CD4^+,CD8^+,CD4^+/CD8^+)were measured,and the clinical effects and complications were evaluated.Results After treatment,CAT score(8.23±3.64,10.41±4.08)and MMRC score(1.35±0.82,1.77±0.61)of the two groups were lower than those before treatment(23.01±4.47,22.87±5.26,2.79±0.54,3.04±0.74),and the decrease in the observation group was greater than that in the control group(all P<0.05).After treatment,the detection rates of Klebsiella pneumoniae,Escherichia coli,Pseudomonas aeruginosa and,Streptococcus pneumoniae were lower than those before treatment in the two groups(all P<0.05).There was no statistical significance(all P>0.05).After treatment,the quantities of Bifidobacterium,Lactobacillus acidophilus,Enterococcus faecalis in two groups of patients after treatment were higher than before treatment and Escherichia coli decreased.The improvement of the observation group was better than that of the control group(P<0.05).After treatment,CD4^+cells and CD4^+/CD8^+in the two groups were higher than those before treatment,and the observation group was higher than the control group(all P<0.05).There was no significant difference in the number of CD8^+cells between the two groups before and after treatment(all P>0.05).After treatment,the incidence of abdominal distension(18.4%)and gastric retention(20.4%)in the observation group were lower than those in the control group(36.7%,38.8%),with statistically significant difference(P<0.05),and there was no significant difference in the incidence of stress ulcer(20.4%,24.5%).Conclusion Microecologics combined with Moxifloxacin sequential therapy in elderly patients with COPD combined with LRTI can promote intestinal microecological balance,regulate immune function,and then improve the patients′condition.