脾多肽注射液联合亚胺培南西司他丁钠治疗老年重症社区获得性肺炎的疗效及机制

Study on the effect and mechanism of spleen polypeptide injection combined with imipenem and cilastatin sodium in the treatment of elderly patients with severe community-acquired pneumonia

目的探讨脾多肽注射液联合亚胺培南西司他丁钠治疗老年重症社区获得性肺炎(SCAP)的临床疗效以及对病人炎症反应和免疫功能的影响。方法选取2018年1月至2020年1月我院收治的92例老年SCAP病人,运用随机数表将其分为观察组与对照组,各46例。对照组予以亚胺培南西司他丁钠治疗,观察组在对照组基础上联合脾多肽注射液治疗,疗程均为14 d。观察2组临床疗效,并比较治疗前后2组炎症反应及免疫功能指标、APACHEⅡ评分、住院时间、28 d病死率及不良反应发生情况。结果观察组总有效率(95.7%,44/46)较对照组(80.4%,37/46)显著提高(P<0.05)。与治疗前相比,2组治疗后血清CRP、IL-6、IL-8水平和APACHEⅡ评分均显著降低(P<0.05),外周血CD3^(+)、CD4^(+)水平及CD4^(+)/CD8^(+)均显著升高(P<0.05),且观察组改善更显著(P<0.05)。与对照组相比,观察组住院时间显著缩短(P<0.05)。2组不良反应发生率及28 d病死率差异均无统计学意义(P>0.05)。结论脾多肽注射液联合亚胺培南西司他丁钠治疗老年SCAP的疗效确切,其作用机制可能是通过有效抑制全身炎症反应及增强机体免疫功能来实现的。

Objective To investigate the clinical efficacy of spleen polypeptide injection combined with imipenem and cilastatin sodium in the treatment of severe community acquired pneumonia(SCAP)and the effects on the levels of C-reactive protein(CRP),interleukin(IL)-6,IL-8 and T lymphocyte subpopulation in the elderly patients.Methods From January 2018 to January 2020,a total of 92 elderly patients with SCAP were randomly divided into the observation group and the control group,with 46 cases in each group.The control group was treated with imipenem and cilastatin sodium,and the observation group was treated with spleen polypeptide injection on the basis of the control group for 14 days.The levels of CRP,IL-6,IL-8 and T lymphocyte subpopulation(CD3^(+),CD4^(+),CD4^(+)/CD8^(+))and APACHEⅡscores of the two groups were compared before and after treatment.The clinical effects and the length of stay,28-day mortality and adverse rections were recorded.Results The total effective rate of the observation group was 95.7%(44/46),which was significantly higher than that of the control group(80.4%,37/46)(P<0.05).After treatment,the levels of CRP,IL-6 and IL-8 were significantly lower,the levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)in peripheral blood were significantly higher,and the scores of APACHEⅡwere significantly decreased in both groups,especially in the observation group(P<0.05).Compared with the control group,the length of hospitalization in the observation group was significantly shorter(P<0.05).There was no significant difference in 28-day mortality and the rate of adverse reactions between the two groups(P>0.05).Conclusions Spleen polypeptide injection combined with imipenem and cilastatin sodium has a satisfactory overall efficacy in the treatment of the elderly patients with SCAP.The mechanism may be related with down-regulating CRP,IL-6 and IL-8 in vivo and maintaining the balance and stability of T lymphocyte subpopulation in peripheral blood.