阿奇霉素联合山莨菪碱和布地奈德治疗社区获得性肺炎疗效观察

Effect of azithromycin combined with anisodamine and budesonide in the treatment of community acquired pneumonia

目的探讨阿奇霉素联合山莨菪碱和布地奈德治疗社区获得性肺炎(CAP)的临床效果。方法选择2018年2月至2019年10月西安国际医学中心医院胸科医院收治的116例CAP患者为研究对象,根据治疗方案分为A组(n=38)、B组(n=38)、C组(n=40)。A组患者给予阿奇霉素、山莨菪碱治疗,B组患者给予阿奇霉素、布地奈德治疗,C组患者给予阿奇霉素、山莨菪碱、布地奈德治疗,3组患者疗程均为7 d。观察3组患者胸闷、气促、咳痰、咳嗽、发热等临床症状消失时间,并观察治疗期间患者不良反应。治疗前及治疗7 d后,使用肺功能检测仪检查患者第1秒用力呼气量(FEV 1)、用力肺活量(FVC)和肺一氧化碳弥散量(DLCO),采用酶联免疫吸附法检测血清白细胞三烯B4(LTB4)、可溶性白细胞介素-2受体(sIL-2R)、表面活性蛋白A(SP-A)、半胱氨酰白细胞三烯(CysLTs)及白细胞介素-6(IL-6)水平,使用流式细胞仪检测T淋巴细胞亚群CD^3+、CD^4+、CD^4+/CD^8+水平。结果A组与B组患者胸闷、气促、咳痰、咳嗽及发热的消失时间比较差异无统计学意义(P>0.05),C组患者胸闷、气促、咳痰、咳嗽、发热的消失时间显著短于A组和B组(P<0.05)。治疗前3组患者FEV 1、FVC、DLCO比较差异无统计学意义(P>0.05),3组患者治疗后FEV 1、FVC、DLCO显著高于治疗前(P<0.05);治疗后,A组与B组患者FEV 1、FVC、DLCO比较差异无统计学意义(P>0.05),C组患者FEV 1、FVC、DLCO显著高于A组和B组(P<0.05)。治疗前3组患者血清LTB4、sIL-2R、SP-A、CysLTs、IL-6水平比较差异无统计学意义(P>0.05),3组患者治疗后血清LTB4、sIL-2R、SP-A、CysLTs、IL-6水平显著低于治疗前(P<0.05);治疗后,C组患者血清LTB4、sIL-2R、SP-A、CysLTs、IL-6水平显著低于A组和B组(P<0.05),A组与B组患者血清LTB4、sIL-2R、SP-A、CysLTs、IL-6水平比较差异无统计学意义(P>0.05)。治疗前3组患者CD^3+、CD^4+、CD^4+/CD^8+水平比较差异无统计学意义(P>0.05),3组患者治疗后CD^3+、CD^4+、CD^4+/CD^8+水平显著高于治疗前(P<0.05);治疗后,C组患者CD^3+、CD^4+、CD^4+/CD^8+水平显著高于A组和B组(P<0.05),A组与B组患者CD^3+、CD^4+、CD^4+/CD^8+水平比较差异无统计学意义(P>0.05)。A组、B组和C组患者不良反应发生率分别为13.16%(5/38)、13.16%(5/38)、17.50%(7/40),3组患者不良反应发生率比较差异无统计学意义(χ2=0.962,P>0.05)。结论阿奇霉素联合山莨菪碱和布地奈德可快速缓解CAP患者临床症状,抑制炎症反应,改善肺功能和免疫功能。

Objective To investigate the clinical effect of azithromycin combined with anisodamine and budesonide in the treatment of community acquired pneumonia(CAP).Methods A total of 116 patients with CAP admitted to the Chest Hospital of Xi′an International Medical Center Hospital from February 2018 to October 2019 were selected as the research subjects,and the patients were divided into group A(n=38),group B(n=38)and group C(n=40)according to the treatment plan.The patients in the group A were treated with azithromycin and anisodamine,and the patients in the group B were treated with azithromycin and budesonide,while the patients in the group C were treated with azithromycin,anisodamine and budesonide.The course of treatment in the three groups was 7 days.The disappearance time of clinical symptoms such as chest distress,tachypnea,expectoration,cough,fever and so on of the patients in the three groups were observed,and the adverse reactions during the treatment were observed.Before treatment and after 7 days of treatment,the first second forced expiratory volume(FEV 1),forced vital capacity(FVC)and diffusing capacity of the lung for carbon monoxide(DLCO)were measured by pulmonary function analyzer;the levels of serum leukotrienes B4(LTB4),soluble interleukin-2 receptor(sIL-2R),surfactant protein A(SP-A),cysteinyl leukotrienes(CysLTs)and interleukin-6(IL-6)were detected by enzyme linked immunosorbent assay;the levels of CD^3+,CD^4+,CD^4+/CD^8+were detected by flow cytometry.Results There was no significant difference in the disappearance time of chest distress,tachypnea,expectoration,cough and fever between the group A and group B(P>0.05).The disappearance time of chest distress,tachypnea,expectoration,cough and fever in the group C was significantly shorter than that in the group A and group B(P<0.05).There was no significant difference in the FEV 1,FVC and DLCO among the three groups before treatment(P>0.05).The FEV 1,FVC and DLCO after treatment were significantly higher than those before treatment in the three groups(P<0.05).After treatment,there was no significant difference in the FEV 1,FVC and DLCO between the group A and group B(P>0.05);while the FEV 1,FVC and DLCO in the group C were significantly higher than those in the group A and group B(P<0.05).There was no significant difference in serum LTB4,sIL-2R,SP-A,CysLTs and IL-6 levels among the three groups before treatment(P>0.05).The levels of serum LTB4,sIL-2R,SP-A,CysLTs and IL-6 after treatment were significantly lower than those before treatment in the three groups(P<0.05).After treatment,the levels of serum LTB4,sIL-2R,SP-A,CysLTs and IL-6 in the group C were significantly lower than those in the group A and group B(P<0.05);but there was no significant difference in the levels of serum LTB4,sIL-2R,SP-A,CysLTs and IL-6 between the group A and group B(P>0.05).There was no significant difference in the levels of CD^3+,CD^4+,CD^4+/CD^8+among the three groups before treatment(P>0.05).The levels of CD^3+,CD^4+,CD^4+/CD^8+after treatment were significantly higher than those before treatment in the three groups(P<0.05).After treatment,the levels of CD^3+,CD^4+,CD^4+/CD^8+in the group C were significantly higher than those in the group A and group B(P<0.05);but there was no significant difference in the levels of CD^3+,CD^4+,CD^4+/CD^8+between the group A and group B(P>0.05).The incidence of adverse reactions in the group A,group B and group C was 13.16%(5/38),13.16%(5/38)and 17.50%(7/40),respectively.There was no significant difference in the incidence of adverse reactions among the three groups(χ2=0.962,P>0.05).Conclusion Azithromycin combined with anisodamine and budesonide can quickly relieve the clinical symptoms,inhibit inflammatory reaction,and improve lung function and immune function of patients with CAP.