多黏菌素治疗多药耐药革兰阴性杆菌感染肺炎的效果

Effect of polymyxin on treatment of pneumonia caused by multidrug-resistant gram-negative bacilli

目的探讨多药耐药革兰阴性杆菌感染肺炎患者多黏菌素治疗疗效及其与血浆miRNA-155、miRNA-223-3p、miRNA-150-5p的关系。方法选择2019年1月-2020年1月衡水市人民医院呼吸与危重科确诊的82例多药耐药革兰阴性杆菌感染肺炎患者为研究对象,随机数字表法按1∶1比例分为研究组和对照组,各41例,对照组常规抗感染治疗,研究组在对照组基础上联合多黏菌素治疗。比较两组疗效,观察治疗前后两组血浆miRNA-155、miRNA-223-3p、miRNA-150-5p表达量,对比两组细菌清除率和药物安全性,同时分析多药耐药革兰阴性杆菌感染肺炎患者多黏菌素治疗疗效与血浆miR-155、miRNA-223-3p、miRNA-150-5p的关系。结果研究组治疗总有效率90.24%高于对照组(P<0.05);治疗后两组血浆miRNA-155、miRNA-223-3p、miRNA-150-5p表达量较治疗前降低,且研究组低于对照组(P<0.05);治疗后研究组细菌清除率95.65%高于对照组(P<0.05);两组不良反应总发生率比较,无统计学差异;治愈患者血浆miRNA-155、miRNA-223-3p、miRNA-150-5p表达量低于有效、无效患者,有效患者亦低于无效患者(P<0.05)。结论多黏菌素治疗多药耐药革兰阴性杆菌感染肺炎患者的疗效明显,同时可降低患者血浆miRNA-155、miRNA-223-3p、miRNA-150-5p水平并提高细菌清除率,且患者疗效与血浆miRNA-155、miRNA-223-3p、miRNA-150-5p水平存在相关性。

OBJECTIVE To explore the effect of polymyxin on treatment of pneumonia caused by multidrug-resistant gram-negative bacilli and observe its relationship with plasma miRNA-155, miRNA-223-3 p and miRNA-150-5 p. METHODS A total of 82 patients who were diagnosed with multidrug-resistant gram-negative bacilli pneumonia in respiratory and critical care medicine department of Hengshui People’s Hospital from Jan 2019 to Jan 2020 were recruited as the study subjects and randomly divided into the study group and the control group in a 1∶1 ratio, with 41 case in each group. The control group was treated with conventional anti-infection therapy, while the study group was treated with polymyxin on basis of the treatment of the control group. The curative effect was compared between the two groups, the expression levels of plasma miRNA-155, miRNA-223-3 p and miRNA-150-5 p were observed and compared between two groups before and after the treatment, the eradication rate of bacteria and safety of drugs were compared between the two groups, and the association between the therapeutic effect of polymyxin and the plasma miR-155, miRNA-223-3 p and miRNA-150-5 p was analyzed. RESULTS The total effective rate of the study group was 90.24%, significantly higher than that of the control group(P<0.05). The expression levels of plasma miRNA-155, miRNA-223-3 p and miRNA-150-5 p of the two groups were significantly lower after the treatment than before the treatment, and the levels of above indexes of the study group were significantly lower than those of the control group(P<0.05). The eradication rate of bacteria of the study group was 95.65% after the treatment, significantly higher than that of the control group(P<0.05). There was no significant difference in the total incidence of adverse reactions between the two groups. The expression levels of plasma miRNA-155, miRNA-223-3 p and miRNA-150-5 p of the cured patients were significantly lower than those of the effective, ineffective patients, and the levels of above indexes of the effective patients were significantly lower than those of the ineffective patients(P<0.05). CONCLUSION Polymyxin can achieve remarkable effect on treatment of the patients with multidrug-resistant gram-negative bacilli pneumonia, reduce the levels of plasma miRNA-155, miRNA-223-3 p and miRNA-150-5 p and rise the eradication rate of bacteria. There is association between the curative effect and the levels of plasma miRNA-155, miRNA-223-3 p and miRNA-150-5 p.