利奈唑胺联合美罗培南治疗重症肺炎疗效观察及对患者肺泡灌洗液中miR-127-5p、miR-3686表达的影响

Efficacy of Linezolid Combined with Meropenem in the Treatment of Severe Pneumonia and Its Effect on the Expressions of miR-127-5p and miR-3686 in Patients’Alveolar Lavage Fluid

目的:观察利奈唑胺联合美罗培南治疗重症肺炎的疗效及对患者肺泡灌洗液中miR-127-5p、miR-3686表达的影响。方法:重症肺炎患者102例随机分为联合组和对照组各51例。两组均给予常规治疗,对照组同时给予美罗培南,联合组在对照组基础上再加用利奈唑胺,均治疗2周。观察两组疗效和临床症状、体征改善时间、药品不良反应;比较两组患者治疗前后血气指标[动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)、血氧饱和度(SaO2)]、肺功能指标[最大呼气中段流量(MMF)、峰流速(PEF)、最大呼气压(PEmax)、最大吸气压(PImax)]、血清炎症因子[肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)、C反应蛋白(CRP)]水平以及肺泡灌洗液中miR-127-5p、miR-3686水平的变化。结果:联合组总有效率为94.12%,高于对照组的76.47%(P<0.05),联合组患者退热时间、痰液颜色改变时间、肺部炎症吸收>50%时间等均短于对照组(P<0.01);治疗后,两组PaCO2、血清TNF-α、PCT、CRP水平以及肺泡灌洗液中miR-3686水平较治疗前明显下降,PaO2、SaO2、MMF、PEF、PEmax、PImax水平以及肺泡灌洗液中miR-127-5p水平则较治疗前明显提高(P<0.05),且联合组上述各项指标均优于对照组(P<0.05);两组不良反应发生率差异无统计学意义(P>0.05)。结论:利奈唑胺联合美罗培南治疗重症肺炎可较快缓解临床症状、体征,改善血气情况与肺功能,减轻炎症反应,调节肺泡灌洗液miR-127-5p、miR-3686表达,提高疗效,且安全性较好。

Objective:To observe the efficacy of linezolid combined with meropenem in the treatment of severe pneumonia and its effect on the expressions of miR-127-5p and miR-3686 in patients’alveolar lavage fluid.Methods:Totally 102 patients with severe pneumonia were randomly divided into combined group and control group with 51 cases in each group.Both groups were given the conventional treatment,and the control group was given meropenem at the same time,and the combined group was given linezolid on the basis of the control group.Both groups were treated for 2 weeks.The efficacy and clinical symptoms,improvement time of signs and adverse drug reactions were observed in the two groups.The blood gas indices[arterial partial pressure of carbon dioxide(PaCO2),arterial partial pressure of oxygen(PaO2),blood oxygen saturation(SaO2)],lung function indices[maximum expiratory flow(MMF),peak expiratory flow(PEF),maximum expiratory pressure(PEmax),maximum inspiratory pressure(Pimax)],serum inflammatory factors[tumor necrosis factor-α(TNF-α),procalcitonin(PCT),C-reactive protein(CRP)],and the changes of miR-127-5p and miR-3686 levels in alveolar lavage fluid before and after treatment were compared between the two groups.Results:The total effective rate of the combined group was 94.12%,which was higher than that(76.47%)of the control group(P<0.05).The time of antipyretic,sputum color change and absorption of lung inflammation above 50%in the combined group were shorter than that in the control group(P<0.01).After treatment,the levels of PaCO2,serum TNF-α,PCT and CRP,and the level of miR-3686 in the alveolar lavage fluid of the two groups were significantly lower than those before treatment.The levels of PaO2,SaO2,MMF,PEF,PEmax and Pimax,and the level of miR-127-5p in the alveolar lavage fluid were significantly higher than those before treatment(P<0.05).And the above indicators of the combined group were better than those of the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Linezolid combined with meropenem in the treatment of severe pneumonia can quickly relieve clinical symptoms and signs,improve blood gas and lung function,reduce inflammation and regulate the expressions of miR-127-5p and miR-3686 in alveolar lavage fluid with improved efficacy and high safety.