玉屏风颗粒联合抗菌药物治疗老年社区获得性肺炎患者的临床疗效及对其淋巴细胞亚群的影响

Effect of Yupingfeng Granules Combined with Antibiotics on Clinical Efficacy and Lymphocyte Subpopulation of Elderly Patients with Community-Acquired Pneumonia

目的探讨玉屏风颗粒联合抗菌药物治疗老年社区获得性肺炎患者的临床疗效及对其淋巴细胞亚群的影响。方法选取2018年10月—2020年3月期间滨州医学院附属医院老年科收治的60例的社区获得性肺炎患者,采用随机数字表法分为对照组和试验组,每组各30例。对照组进行常规治疗,试验组在对照组的基础上联合玉屏风颗粒治疗。治疗2周后,观察比较两组患者的症状消失时间(发热、咳喘和肺部啰音),治疗前后炎性指标(白细胞计数(White blood cell count,WBC)、肿瘤坏死因子-α(Tumor necrosis factor-alpha,TNF-α)、白介素-6(Interleukin-6,IL-6))水平、免疫指标(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、CD19^(+)B、自然杀伤细胞(Natural Killer,NK)细胞)水平、肺功能[25%潮气量时呼气流速(Tidal volume during expiratory flow 25%,TEF25%)、功能残气量(Functional residual capacity,FRC)和用力呼气最大流速(Peak expiratory flow rate,PEF)]。结果治疗期间,两组患者抗生素使用情况基本一致,差异无统计学意义(P>0.05);治疗后试验组临床总有效率96.67%(29/30)明显高于对照组80.00%(24/30),差异有统计学意义(P<0.05)。治疗后试验组发热消失时间、咳喘消失时间、肺部啰音消失时间均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者WBC、TNF-α、IL-6水平均较治疗前明显降低,差异有统计学意义(P<0.05);且试验组TNF-α、IL-6水平较对照组明显降低,差异有统计学意义(P<0.05),WBC水平与对照组比较,差异无统计学意义(P>0.05)。治疗后两组患者CD3^(+)、CD4^(+)细胞水平及CD4^(+)/CD8^(+)均较治疗前明显升高,CD8^(+)细胞水平较治疗前明显降低,差异有统计学意义(P<0.05);试验组CD19^(+)B、NK细胞水平较治疗前明显升高,差异有统计学意义(P<0.05);对照组CD19^(+)B、NK细胞水平治疗前后比较,差异无统计学意义(P>0.05)。治疗后试验组CD3^(+)、CD4^(+)、CD19^(+)B细胞水平及CD4^(+)/CD8^(+)均较对照组明显升高,CD8^(+)细胞水平较对照组明显降低,差异有统计学意义(P<0.05);治疗后两组患者NK细胞水平比较,差异无统计学意义(P>0.05)。治疗后两组患者PEF、FRC、TEF25%均较治疗前明显升高,差异有统计学意义(P<0.05);且试验组PEF、FRC、TEF25%水平均较对照组明显升高,差异有统计学意义(P<0.05)。治疗期间,两组患者均无不良反应发生。结论玉屏风颗粒辅助治疗老年社区获得性肺炎患者临床疗效较好,其机制可能与调节T、B淋巴细胞,降低IL-6和TNF-α细胞因子来调节免疫失衡,提高机体免疫功能有关。

Objective To explore the clinical efficacy of Yupingfeng Granules combined with antibiotics in elderly patients with community-acquired pneumonia and the effect on lymphocyte subpopulation.Methods A total of 60 elderly patients with community-acquired pneumonia enrolled in the Geriatrics Department of Binzhou Medical University Hospital from October 2018 to March 2020 were studied.They were divided into a control group and an experimental group by the random number table method.There were 30 cases in each group.Patients in the control group received conventional treatment,and those in the experimental group received Yupingfeng Granules combined on the basis of conventional treatment for two weeks.Disappearing time of fever,cough,and lung murmur in both groups was compared after treatment.The level of inflammatory indicators,including white blood cell count(WBC),tumor necrosis factor-alpha(TNF-α),and interleukin-6(IL-6),as well as immune indicators(CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+),CD19^(+)B,and natural killer(NK)cells)and lung function indicators,such as tidal volume during expiratory flow 25%(TEF25%),functional residual capacity(FRC),and peak expiratory flow rate(PEF)were compared before and after treatment in both groups.Results The antibiotic treatment in both groups was basically consistent,and the difference was not statistically significant(P>0.05).The clinical total efficacy rate in the experimental group was significantly higher than that in the control group,and the difference was statistically significant(P<0.05).Disappearing time of fever,cough,and lung murmur in the experimental group was significantly lower than that in the control group(P>0.05).After the treatment,the levels of WBC,TNF-α,and IL-6 in both groups were significantly reduced(P<0.05).The levels of TNF-αand IL-6 in the experimental group were significantly lower than those in the control group(P<0.05),while there was no significant difference in WBC level between the two groups(P>0.05).After the treatment,the levels of CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)in the two groups were significantly improved,and the level of CD8^(+)was significantly reduced(P<0.05).The levels of CD19^(+)B and NK cells in the experimental group were significantly higher than those before treatment(P<0.05).There was no significant difference in CD19^(+)B and NK cells before and after treatment in the control group(P<0.05).After treatment,the levels of CD3^(+),CD4^(+),and CD19^(+)B cells,as well as CD4^(+)/CD8^(+)in the experimental group were significantly higher than those in the control group,and the level of CD8^(+)cells was significantly lower than that in the control group(P<0.05).There was no significant difference in NK cell levels between the two groups after treatment(P>0.05).After treatment,PEF,FRC,and TEF25%of patients in the two groups were significantly higher than those before treatment(P<0.05).The levels of PEF,FRC,and TEF25%in the experimental groups were significantly higher than those in the control group(P<0.05).No adverse reactions occurred in both groups during treatment.Conclusion The adjuvant treatment of Yupingfeng Granules for elderly patients with community-acquired pneumonia has a better clinical effect.The mechanism may be related to regulating T and B lymphocytes and reducing IL-6 and TNF-αto regulate immune imbalance and improve elderly patients′immune function.