β-内酰胺类抗菌药物联合胸腺肽治疗慢阻肺并发肺部感染的临床疗效

Clinical effect ofβ-lactams antibiotics combined with thymosin on treatment of chronic obstructive pulmonary disease complicated with pulmonary infection

目的研究β-内酰胺类抗菌药物联合胸腺肽对慢阻肺并发肺部感染患者的治疗效果.方法选取2018年4月-2019年4月天津市第五中心医院呼吸科收治的慢阻肺并发肺部感染患者96例,按照随机数字表法分为胸腺肽组和联合组各48例,胸腺肽组采用胸腺肽治疗,联合组采用β-内酰胺类抗菌药物阿莫西林联合胸腺肽治疗,采集桡动脉血检测血氧饱和度(SaO_(2))、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2)),采用实时荧光定量PCR检测Toll样受体2(TLR2)mRNA、TLR4 mRNA的表达,肺部感染评分(CPIS)、慢性健康状况评分系统(APACHEⅡ)评估病情,观察两组治疗前后肺功能指标每分钟静息通气量(VE)、第1秒用力呼气量(FEV1)、肺总量(TLC),根据临床症状改善情况评价临床疗效.结果治疗后联合组血气指标PaCO_(2)低于胸腺肽组,PaO_(2)、SaO_(2)明显高于胸腺肽组(P<0.05);联合组TLR2 mRNA、TLR4 mRNA水平均低于胸腺肽组(P<0.05);联合组CPIS、APACHEⅡ评分均低于胸腺肽组(P<0.05);联合组肺功能指标FEV1、VE均高于胸腺肽组,T LC低于胸腺肽组(P<0.05);联合组治疗有效率95.83%高于胸腺肽组的83.33%,差异有统计学意义(χ^(2)=4.019,P=0.045).结论β-内酰胺类抗菌药物阿莫西林联合胸腺肽可明显改善慢阻肺并发肺部感染患者血气、肺功能,抑制肺部感染进展,其机制可能与改善TLR2和TLR4表达相关.

OBJECTIVE To study the effect ofβ-lactams antibiotics combined with thymosin on treatment of chronic obstructive pulmonary disease(COPD)patients complicated with pulmonary infection.METHODS A total of 96 COPD patients complicated with pulmonary infection who were treated in respiratory department of the Fifth Central Hospital of Tianjin from Apr 2018 to Apr 2019 were enrolled in the study and randomly divided into the thymosin group and the combined group,with 48 cases in each group.The thymosin group was treated with thymosin,while the combined group was treated withβ-lactams antibiotic amoxicillin combined with thymosin.The radial artery blood specimens were collected to detect blood oxygen saturation(SaO_(2)),arterial partial pressure of oxygen(PaO_(2))and arterial partial pressure of carbon dioxide(PaCO_(2)),the expression of TLR2 mRNA and TLR4 mRNA was detected by using real-time fluorescence quantitative PCR,the illness condition of the patients was evaluated by clinical pulmonary infection score(CPIS)and acute physiology and chronic health evaluation scoring system(APACHEⅡ);the lung function indexes resting ventilation volume per minute(VE),forced expiratory volume in the first second(FEV1)and total lung capacity(TLC)were observed and compared between the two groups before and after the treatment,and the clinical curative effects were evaluated on the basis of status of improvement of clinical symptoms.RESULTS The blood gas index PaCO_(2) of the combined group was significantly lower than that of the thymosin group after the treatment,the PaO_(2) and SaO_(2) of the combined group were significantly higher than those of the thymosin group(P<0.05);the levels of TLR2 mRNA and TLR4 mRNA of the combined group were significantly lower than those of the thymosin group(P<0.05);the CPIS and APACHEⅡscore of the combine group were significantly lower than those of the thymosin group(P<0.05).The lung function indexes FEV1 and VE of the combined group were significantly higher than those of the thymosin group,and the TLC of the combined group was significantly lower than that of the thymosin group(P<0.05).The effective rate of treatment of the combined group was 95.83%,significantly higher than 83.33%of the thymosin group(χ^(2)=4.019,P=0.045).CONCLUSIONβ-lactams antibiotics combined with thymosin can remarkably improve the blood gas and lung function of the COPD patients complicated with pulmonary infection,inhibit the progression of pulmonary infection,and the mechanisms may be associated with the improvement of expression of TLR2 and TLR4.