胸腺肽联合莫西沙星治疗老年慢性阻塞性肺疾病合并重症肺炎的效果

Efficay of thymosin combined with moxifloxacin in treatment of elderly patients with chronic obstructive pulmonary disease complicated with severe pneumonia

目的 观察胸腺肽联合莫西沙星治疗老年慢性阻塞性肺疾病(COPD)合并重症肺炎(SP)的效果。方法 2022年3月至2023年11月乐山市中医医院收治的老年COPD合并SP患者78例,通过随机数字表法分为莫西沙星组与联合组,各39例。莫西沙星组予以常规治疗加莫西沙星药物,常规治疗按照COPD指南相关规定规律吸入长效支气管扩张剂,必要时吸入短效激动剂、雾化吸入糖皮质激素或给予茶碱类药物;并针对SP行退热、氧疗、平喘化痰、营养支持等治疗;联合组在莫西沙星组的基础上增加胸腺肽治疗,两组均治疗14 d。比较两组治疗14 d后临床疗效,症状改善情况,治疗前、治疗14 d后体液免疫、炎症反应以及治疗期间的总不良反应发生率。结果 治疗14 d后联合组总有效率高于莫西沙星组(94.87%vs 76.92%,χ^(2)=5.186,P<0.05)。联合组高热、咳嗽、肺部啰音消失时间为(3.22±0.56) d、(6.27±1.21) d、(7.29±1.27) d,短于莫西沙星组的(4.05±0.61) d、(7.12±1.10) d、(8.87±1.42) d,组间比较差异有统计学意义(t=6.260,3.246,5.179,均P<0.05)。与治疗前比较,治疗14 d后两组血清免疫球蛋白Ig A、Ig G、Ig M水平升高,联合组为(2.05±0.61) g·L^(-1)、(12.70±2.91) g·L^(-1)、(1.75±0.20) g·L^(-1),高于莫西沙星组的(1.76±0.55) g·L^(-1)、(9.53±2.23) g·L^(-1)、(1.43±0.21) g·L^(-1),组间比较差异有统计学意义(t=2.205,5.400,6.891,均P<0.05)。治疗14 d后联合组全血白细胞(WBC),血清降钙素原(PCT)、超敏C反应蛋白(hsCRP)水平为(8.38±1.09)×10^(9)·L^(-1)、(0.15±0.04) ng·m L^(-1)、(2.54±0.89) mg·L^(-1),低于莫西沙星组的(9.89±1.17)×10^(9)·L^(-1)、(0.26±0.07) ng·m L^(-1)、(5.39±0.92) mg·L^(-1),组间比较差异有统计学意义(t=5.897,8.521,13.904,均P<0.05)。治疗期间莫西沙星组总不良反应发生率7.69%(3/39),与联合组的15.38%(6/39)比较,差异无统计学意义(χ^(2)=0.502,P=0.478)。结论 胸腺肽联合莫西沙星对老年COPD合并SP疗效确切,可改善体液免疫、缓解炎症反应,安全性良好。

Objective To investigate the efficacy of thymosin combined with moxifloxacin in the treatment of elderly patients with chronic obstructive pulmonary disease(COPD)complicated with severe pneumonia(SP).Methods A total of 78 elderly patients with COPD complicated with SP admitted to Leshan Hospital of Traditional Chinese Medicine from March 2022 to November 2023 were enrolled in this study and divided into the moxifloxacin group and the combined group,with 39 patients in each group,by random number table method.The patients in the moxifloxacin group received routine treatment and moxifloxacin.Routine treatment involved regular inhalation of long-acting bronchodilators according to the relevant provisions of the COPD guidelines and inhalation of short-acting agonists when necessary.Inhalation of glucocorticoids or administration of theophylline drugs were also considered.Additionally,treatments for secondary pneumonia(SP)included fever reduction,oxygen therapy,asthma relief,expectoration promotion and nutritional support.The patients in the combined group received thymopeptide therapy in addition to the treatment provided to the moxifloxacin group.All the patients in both groups were treated for 14 days.The clinical efficacy,symptom improvement,humoral immunity,inflammatory response and safety during treatment were compared between the two groups after 14 days of treatment.Results After 14 days of treatment,the total effective rate of the combined group was higher than that of the moxifloxacin group(94.87%vs 76.92%,χ^(2)=5.186,P<0.05).The disappearance time of high fever,cough and lung rale in the combined group was(3.22±0.56)d,(6.27±1.21)d and(7.29±1.27)d,which was shorter than that in the moxifloxacin group((4.05±0.61)d,(7.12±1.10)d,(8.87±1.42)d),there was a statistically significant difference between the two groups(t=6.260,3.246,5.179,all P<0.05).Compared with those before the treatment,serum immunoglobulin(Ig)A,IgG and IgM levels were increased in the two groups after 14 days of treatment.They were(2.05±0.61)g·L^(-1),(12.70±2.91)g·L^(-1) and(1.75±0.20)g·L^(-1) in the combined group,which were higher than those of(1.76±0.55)g·L^(-1),(9.53±2.23)g·L^(-1) and(1.43±0.21)g·L^(-1) in the moxifloxacin group(t=2.205,5.400,6.891,all P<0.05).Compared with those before treatment,the levels of whole blood white blood cells(WBC),serum procalcitonin(PCT)and hypersensitive C-reactive protein(hs-CRP)in the two groups were decreased after 14 days of treatment.They were(8.38±1.09)×10^(9)·L^(-1),(0.15±0.04)ng·mL^(-1) and(2.54±0.89)mg·L^(-1) in the combined group,which were lower than those of the moxifloxacin group((9.89±1.17)×10^(9)·L^(-1),(0.26±0.07)ng·mL^(-1),(5.39±0.92)mg·L^(-1))(t=5.897,8.521,13.904,all P<0.05).The incidence of adverse reactions showed no significant difference between the moxifloxacin group and the combined group(7.69%(3/39)vs 15.38%(6/39),χ^(2)=0.502,P=0.478).Conclusion Thymosin combined with moxifloxacin is effective for the treatment of elderly patients with COPD complicated with SP since it can improve humoral immunity and relieve inflammation.Meanwhile,this regimen is of high safety.