CBP协同左西孟旦联合伊伐布雷定治疗重症肺炎合并心力衰竭患者疗效观察及对MIP-2、IgG水平的影响

Therapeutic effect of CBP combined with levosimendan and ivabradine in patients with severe pneumonia complicated with heart failure and its effect on MIP-2,IgG level

目的观察连续性血液净化(CBP)协同左西孟旦联合伊伐布雷定治疗重症肺炎合并心力衰竭患者疗效观察及对巨噬细胞炎性蛋白-2(MIP-2)、免疫球蛋白G(IgG)水平的影响。方法前瞻性选取2018年6月至2020年7月张家口市第一医院收治的重症肺炎合并心力衰竭患者120例,根据入院前后顺序随机数字表法分为2组。对照组60例给予左西孟旦联合伊伐布雷定治疗,观察组60例在药物治疗基础上应用CBP协同治疗。统计2组患者的总有效率,记录2组患者左心室射血分数(LVEF)、平均动脉压(MAP)、中心静脉压(CVP)及IgG、巨噬细胞炎性蛋白[巨噬细胞炎性蛋白-1α(MIP-1α)、MIP-2]、炎症因子[降钙素原(PCT)、白细胞计数(WBC)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]的差异。结果观察组的总有效率(91.67%)高于对照组(76.67%),差异有统计学意义(P<0.05)。治疗10 d后,观察组LVEF为(49.87±7.02)%,高于对照组[(44.87±6.33)%],MAP、CVP为(116.89±11.25)mmHg、(10.15±3.02)cmH_(2)O,与对照组[(113.26±10.12)mmHg、(10.23±2.89)cmH_(2)O]比较,差异无统计学意义(P>0.05)。治疗10 d后,观察组IgG为(11.85±0.84)g/L,高于对照组[(9.41±0.74)g/L],血清中MIP-1α、MIP-2、PCT、WBC、IL-6、TNF-α分别为[(30.05±2.48)ng/mL、(64.23±7.12)ng/L、(0.89±0.27)μg/L、(7.95±1.02)×10^(9)/L、(58.02±21.41)ng/L、(71.23±21.56)ng/L],均低于对照组[(32.23±2.85)ng/mL、(75.23±8.45)ng/L、(1.32±0.23)μg/L、(10.52±1.36)×10^(9)/L、(85.23±24.05)ng/L、(92.32±28.11)ng/L],差异均有统计学意义(P<0.05)。结论CBP协同左西孟旦联合伊伐布雷定治疗重症肺炎合并心力衰竭可降低MIP-1α、MIP-2等细胞因子的表达,减轻炎症反应,改善LVEF和IgG的表达,平稳血流动力学。

Objective To observe the efficacy of continuous blood purification(CBP)combined with levosimendan and ivabradine in the treatment of patients with severe pneumonia complicated with heart failure and its effect on macrophage inflammatory protein-2(MIP-2)and immunoglobulin G(IgG)levels.Methods A prospective selection of 120 patients with severe pneumonia combined with heart failure admitted to Zhangjiakou First Hospital from June 2018 to July 2020 were divided into 2 groups according to the random number table before and after admission.60 cases in the control group were treated with levosimendan combined with ivabradine,and the observation group was treated with CBP on the basis of drug treatment.Statistics of total efficiency in both groups,the differences of left ventricular ejection fraction(LVEF),mean arterial pressure(MAP),central venous pressure(CVP)and IgG,macrophage inflammatory protein[macrophage inflammatory protein-1α(MIP-1α),MIP-2],inflammation-related factors[procalcitonin(PCT),leukocyte count(WBC),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)]were recorded.Results The total effective rate of the observation group(91.67%)was higher than that of the control group(76.67%),and the difference was statistically significant(P<0.05).After 10 days of treatment,the LVEF of the observation group was(49.87±7.02)%,which was higher than that of the control group[(44.87±6.33)%],and the MAP and CVP of the observation group were(116.89±11.25)mmHg and(10.15±3.02)cmH_(2)O,compared with the control group[(113.26±10.12)mmHg,(10.23±2.89)cmH_(2)O],the difference was not statistically significant(P>0.05).After 10 days of treatment,the IgG of the observation group was(11.85±0.84)g/L,which was higher than that of the control group[(9.41±0.74)g/L].The levels of serum MIP-1α,MIP-2,PCT,WBC,IL-6,TNF-α were[(30.05±2.48)ng/mL,(64.23±7.12)ng/L,(0.89±0.27)μg/L,(7.95±1.02)×10^(9)/L,(58.02±21.41)ng/L and(71.23±21.56)ng/L],respectively,which were lower than those of the control group[(32.23±2.85)ng/mL,(75.23±8.45)ng/L,(1.32±0.23)μg/L,(10.52±1.36)×10_(9)/L,(85.23±24.05)ng/L,(92.32±28.11)ng/L],the differences were statistically significant(P<0.05).Conclusion CBP combined with levosimendan and ivabradine in the treatment of severe pneumonia complicated with heart failure can reduce the expression of cytokines such as MIP-1α,MIP-2,inflammatory response,improve the expression of LVEF and IgG,and stabilize hemodynamics.