胸腺肽α1联合伏立康唑序贯治疗慢性阻塞性肺疾病合并侵袭性肺曲霉菌病患者疗效及对外周血细胞免疫功能炎症因子水平的影响

Effects of thymosin alpha-1 combined with voriconazole in sequential treatment of patients with COPD and invasive pulmonary aspergillosis and the impacts on cellular immune function in peripheral blood and inflammatory factor levels

目的探究胸腺肽α1联合伏立康唑序贯治疗慢性阻塞性肺疾病(COPD)合并侵袭性肺曲霉菌(IPA)患者疗效及对外周血细胞免疫功能、炎症因子水平的影响。方法根据治疗方法将杭州市红十字会医院自2020年1月至2023年12月收治的108例COPD合并IPA的患者分为对照组和观察组,各54例,2组患者均接受常规对症治疗,对照组接受伏立康唑治疗,观察组患者在对照组基础上联合胸腺肽α1治疗,比较2组疗效、外周血细胞免疫功能[CD3^(+)淋巴细胞(CD3^(+))、CD4^(+)淋巴细胞(CD4^(+))、CD8^(+)淋巴细胞(CD8^(+))、CD4^(+)/CD8^(+)值]、炎症因子水平[白细胞介素(IL)-6、IL-8、肿瘤坏死因子-α(TNF-α)]、不良反应。结果观察组总有效率(96.3%)高于对照组(81.5%)(χ^(2)=4.594,P=0.032);治疗后,观察组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)值分别为(62±7)%、(44±5)%、(2.4±0.6),高于对照组的(51±7)%、(37±5)%、(2.0±0.6)(t=8.190、7.254、3.290,均P<0.05),观察组CD8^(+)水平为(20±3)%,低于对照组的(27±3)%(t=10.658,P<0.05);治疗后,观察组IL-6、IL-8、TNF-α水平为(27±4)ng/L、(31±6)ng/L、(45±6)ng/L,均低于对照组的(32±4)ng/L、(37±5)ng/L、(53±6)ng/L(t=7.117、6.981、6.586,均P<0.05);2组不良反应发生率比较差异无统计学意义(7.4%与14.8%,χ^(2)=0.787,P=0.375)。结论胸腺肽α1联合伏立康唑序贯治疗较单伏立康唑序贯治疗COPD合并IPA患者疗效更显著,能有效提高患者的免疫功能,降低炎症反应,且临床安全性良好。

Objective To explore the effect of thymosin alpha-1 combined with voriconazole in sequential treatment of patients with chronic obstructive pulmonary disease(COPD)and invasive pulmonary aspergillosis(IPA)and the impacts on cellular immune function in peripheral blood and inflammatory factor levels.Methods According to different treatment methods,a total of 108 patients with COPD and IPA who were admitted to the hospital from January 2020 to December 2023 were divided into the control group and the observation group,with 54 patients in each group.Both groups were given conventional symptomatic treatment.The control group was treated with voriconazole and the observation group was treated with thymosin alpha-1 combined with voriconazole.The two groups were compared on efficacy,cellular immune function in peripheral blood(CD3^(+),CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)),the levels of inflammatory factors[interleukin(IL)-6,IL-8,tumor necrosis factor-α(TNF-α)],and ad-verse reactions.Results The total effective rate of the observation group(96.3%)was significantly higher than that of the control group(81.5%)(χ^(2)=4.594,P-0.032).After treatment,the values of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)in the observation group[(62±7)%,(44±5)%and(2.4±0.6)]were significantly higher than those in the control group[(51±7)%,(37±5)%and(2.0±0.6)](t=8.190,7.254,3.290,all P<0.05).The level of CD8^(+)in the ob-servation group[(20±3)%]was significantly lower than that in the control group[(27±3)%](t=10.658,P<0.05).After treat-ment,the levels of IL-6,IL-8 and TNF-αin the observation group[(27±4)ng/L,(31±6)ng/L and(45±6)ng/L]were significantly lower than those in the control group[(32±4)ng/L,(37±5)ng/L and(53±6)ng/L](t=7.117,6.981,6.586,all P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(7.4%vs 14.8%,χ^(2)=0.787,P=0.375).Conclusion Compared to treatment with voricona-zole alone,sequential treatment with thymosin alpha-1 and voriconazole is more effective for patients with COPD and IPA.It can effectively improve the patients'immune function and reduce inflammatory reactions,with good clinical safety.