乌司他丁联合比阿培南治疗老年重症肺炎的临床效果

Clinical efficacy of ulinastatin combined with biapenem in the treatment of severe pneumonia in elderly patients

目的 观察乌司他丁联合比阿培南治疗老年重症肺炎(SP)的临床效果以及对患者外周血辅助性T细胞17(Th17)/调节性T细胞(Treg)的影响。方法 选取2020年8月—2023年7月江南大学附属医院收治的老年SP患者150例,采用随机数字表法分为UTI联合组和BPM组,各75例。在常规治疗基础上,BPM组予注射用比阿培南治疗,UTI联合组在BPM组基础上联用注射用乌司他丁治疗,2组均持续治疗14 d。比较2组治疗效果、治疗前后血气指标[动脉血二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2))与氧合指数(OI)]、炎性因子[C反应蛋白(CRP)、降钙素原(PCT)、白介素-1β(IL-1β)]、相关免疫细胞亚群指标(Th17、Treg、Th17/Treg),以及不良反应。结果 UTI联合组患者治疗总有效率为96.00%,高于BPM组的84.00%(χ^(2)=6.000,P=0.014)。治疗14 d后,2组PaCO_(2)、CRP、PCT、IL-1β水平、Th17、Th17/Treg均较治疗前降低,PaO_(2)、PaO_(2)/FiO_(2)及Treg水平升高,且UTI联合组降低或升高的程度大于BPM组(P均<0.01)。UTI联合组与BPM组不良反应总发生率(5.33%vs.8.00%)比较差异无统计学意义(χ^(2)=0.429,P=0.513)。结论 乌司他丁联合比阿培南治疗老年SP的临床效果确切,能改善患者血气指标,抑制炎性因子,调节相关免疫细胞亚群,且安全性较高。

Objective To observe the clinical efficacy of ulinastatin combined with biapenem in the treatment of severe pneumonia(SP) in elderly patients,and its effect on peripheral blood helper T cell 17(Th17)/regulatory T cell(Treg) in patients.Methods One hundred and fifty elderly SP patients admitted to the Affiliated Hospital of Jiangnan University from August 2020 to July 2023 were selected.They were divided into an UTI joint group and a BPM group using a random number table method,with 75 cases in each group.On the basis of conventional treatment,the BPM group was treated with Biapenem for Injection,while the UTI joint group received combined therapy of Ulinastatin for Injection on top of the BPM group,with both groups receiving continuous treatment for 14 days.The treatment effects of two groups,changes in blood gas indicators(PaCO_(2),PaO_(2),OI) before and after treatment,levels of inflammatory factors(CRP,PCT,IL-1β),changes in related immune cell subsets(Th17,Treg,Th17/Treg),and occurrence of adverse reactions in both groups were compared.Results The total effective rate of treatment in the UTI joint group was 96.00%,which was higher than the 84.00% in the BPM group(χ^(2)=6.000,P=0.014).After 14 days of treatment,levels of PaCO_(2),CRP,PCT,IL-1β,Th17,and Th17/Treg decreased compared to before treatment in both groups,while levels of PaO_(2),PaO_(2)/FiO_(2),and Treg increased.The degree of decrease or increase in the UTI joint group was greater than that in the BPM group(All P<0.01).There was no statistically significant difference in the total incidence of adverse reactions between the UTI joint group and the BPM group(5.33% vs.8.00%,χ^(2)=0.429,P=0.513).Conclusion The combined therapy of Ulinastatin and Biapenem in treating elderly patients with severe pneumonia has shown precise clinical efficacy,improving patients′ blood gas parameters,inhibiting inflammatory factors,regulating relevant immune cell subsets,and demonstrating relatively high safety.