钠-葡萄糖协同转运蛋白2抑制剂联合葶苈子治疗慢性心力衰竭合并肺部感染的临床疗效分析

Clinical effect of sodium-glucose cotransporter 2 inhibitor combined with Lepidium seed on chronic heart failure complicated by pulmonary infection

目的探讨钠-葡萄糖协同转运蛋白2抑制剂联合葶苈子治疗对心力衰竭(心衰)合并肺部感染患者心功能、消化功能及肺功能的影响。方法选取秭归县中医院2017年8月至2019年3月收治的168例心衰合并肺部感染患者作为研究对象。根据治疗方法不同将患者分为观察组和对照组,每组84例。对照组接受钠-葡萄糖协同转运蛋白2抑制剂联合头孢他啶治疗,观察组在对照组基础上接受葶苈子治疗,共治疗30 d。比较两组治疗前后营养状态指标〔血清前白蛋白(PA)、白蛋白(ALB)、红细胞计数(RBC)、体质量指数(BMI)〕、免疫功能指标〔分化簇抗原(CD3、CD4、CD8)、免疫球蛋白(IgG、IgM)〕、血清炎症因子〔白细胞介素(IL-8、IL-10、IL-17)及肿瘤坏死因子(TNF-α)〕、肠道菌群(肠球菌、大肠埃希菌、乳杆菌、双歧杆菌、酵母菌、消化球菌)、心肺功能指标〔动脉血氧饱和度(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、心率、最大摄氧量(VO_(2)max)、最大运动负荷(Wmax)、最大氧脉搏、无氧阈值(AT)、第1秒用力呼气容积/用力肺活量比值(FEV1/FVC)、FEV1和每分最大通气量(MVV)〕。结果两组治疗后PA、ALB、RBC、BMI、CD3、CD4、CD8、IgG、IgM、乳杆菌、双歧杆菌、PaO_(2)、VO_(2)max、Wmax、最大氧脉搏、AT、FEV1/FVC、FEV1、MVV均较治疗前明显升高,IL-8、IL-17、TNF-α、肠球菌、大肠埃希菌、PaCO_(2)、心率水平均较治疗前明显降低,且观察组治疗后PA、ALB、RBC、BMI、CD3、IgG、IgM、IL-10、双歧杆菌、乳酸菌、PaO_(2)、VO_(2)max、Wmax、最大氧脉搏、AT、FEV1/FVC、FEV1、MVV水平均明显高于对照组〔PA(mg/L):259.69±20.73比217.69±20.73,ALB(g/L):41.46±4.58比36.56±3.73,RBC(×1012/L):4.52±0.24比4.21±0.31,BMI(kg/m2):22.37±2.73比19.66±2.24,CD3:0.63±0.08比0.56±0.08,IgG(g/L):21.85±3.68比15.72±4.36,IgM(g/L):4.68±1.68比3.73±1.67,IL-10(ng/L):65.28±7.23比50.23±6.14,双歧杆菌(CFU/kg):83.5±8.6比78.5±8.3,乳酸菌(CFU/kg):62.1±6.5比53.5±6.0,PaO_(2)(mmHg,1 mmHg≈0.133 kPa):98.36±1.75比91.95±2.95,VO_(2)max(L/min):1.71±0.35比1.22±0.39,Wmax(W):127.49±19.54比97.49±15.37,最大氧脉搏(L/次):11.27±2.42比9.46±2.79,AT:(50.49±7.48)%比(41.35±6.67)%,FEV1/FVC:(75.68±5.86)%比(65.48±8.54)%,FEV1:(82.44±5.73)%比(73.57±7.75)%,MVV(L/min):74.86±10.64比64.63±9.68,均P<0.05〕,CD4、CD8、IL-8、IL-17、TNF-α、肠球菌、大肠埃希菌、PaCO_(2)、心率水平均显著低于对照组〔CD4:0.32±0.06比0.39±0.05,CD8:0.28±0.06比0.34±0.05,IL-8(ng/L):16.64±2.63比26.35±4.13,IL-17(ng/L):112.38±30.16比207.75±42.23,TNF-α(ng/L):45.27±10.23比61.26±14.29,肠球菌(CFU/kg):63.6±5.6比69.5±6.8,大肠埃希菌(CFU/kg):65.8±6.4比70.5±7.0,PaCO_(2)(mmHg):41.84±4.45比56.18±5.37,心率(次/min):75.96±11.57比91.75±12.68,均P<0.05〕。结论葶苈子联合钠-葡萄糖协同转运蛋白2抑制剂治疗心衰合并肺部感染,可有效改善患者心肺功能,降低炎症指标水平,提升患者的营养状态,纠正肠道菌群情况,对临床治疗有一定指导意义。

Objective To investigate the effects of sodium-glucose cotransporter 2 inhibitor combined with Lepidium seed on cardiac,digestive,and pulmonary function in patients with heart failure complicated by pulmonary infection.Methods A total of 168 patients with heart failure and lung infection admitted to Zigui County Hospital of Traditional Chinese Medicine from August 2017 to March 2019 were selected as the research objects.They were divided into observation group and control group according to different treatment methods(84 patients per group).The control group received sodium-glucose cotransporter 2 inhibitor combined with ceftazidime,while the observation group was treated with Lepidium seed on the basis of control group for 30 days.Nutritional status[prealbumin(PA),albumin(ALB),red blood cell count(RBC),body mass index(BMI)],immune function[cytoplasmic domains(CD3,CD4,CD8),immunoglobulins(IgG,IgM)],inflammatory cytokines[interleukins(IL-8,IL-10,IL-17),tumor necrosis factor-α(TNF-α)],intestinal flora(Enterococcus,Escherichia coli,Lactobacillus,Bifidobacterium,Saccharomycetes,Digestion),and cardiopulmonary function[arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),heart rate(HR),maximum oxygen consumption(VO_(2)max),maximum exercise load(Wmax),maximum oxygen pulse,anaerobic threshold(AT),forced expiratory volume in one second/forced lung volume ratio(FEV1/FVC),FEV1 and maximal voluntary ventilation(MVV)]were compared between the two groups before and after treatment.Results After treatment,PA,ALB,RBC,BMI,CD3,CD4,CD8,IgG and IgM,Lactobacillus,Bifidobacterium,PaO_(2),VO_(2)max,Wmax,maximum oxygen pulse,AT,FEV1/FVC,FEV1,MVV all increased significantly compared to before treatment.IL-8,IL-17,TNF-α,Enterococcus,Escherichia coli,PaCO_(2),and heart rate were significantly reduced compared to before treatment.The levels of PA,ALB,RBC,BMI,CD3,IgG,IgM,IL-10,Bifidobacterium,Lactobacillus,PaO_(2),VO_(2)max,Wmax,maximum oxygen pulse,AT,FEV1/FVC,FEV1,and MVV in the observation group were significantly higher than those in the control group after treatment[PA(mg/L):259.69±20.73 vs.217.69±20.73,ALB(g/L):41.46±4.58 vs.36.56±3.73,RBC(×1012/L):4.52±0.24 vs.4.21±0.31,BMI(kg/m2):22.37±2.73 vs.19.66±2.24,CD3:0.63±0.08 vs.0.56±0.08,IgG(g/L):21.85±3.68 vs.15.72±4.36,IgM(g/L):4.68±1.68 vs.3.73±1.67,IL-10(ng/L):65.28±7.23 vs.50.23±6.14,Bifidobacterium(CFU/kg):83.5±8.6 vs.78.5±8.3,Lactobacillus(CFU/kg):62.1±6.5 vs.53.5±6.0,PaO_(2)(mmHg,1 mmHg≈0.133 kPa):98.36±1.75 vs.91.95±2.95,VO_(2)max(L/min):1.71±0.35 vs.1.22±0.39,Wmax(W):127.49±19.54 vs.97.49±15.37,maximum oxygen pulse(L/time):11.27±2.42 vs.9.46±2.79,AT:(50.49±7.48)%vs.(41.35±6.67)%,FEV1/FVC:(75.68±5.86)%vs.(65.48±8.54)%,FEV1:(82.44±5.73)%vs.(73.57±7.75)%,MVV(L/min):74.86±10.64 vs.64.63±9.68,all P<0.05].CD4,CD8,IL-8,IL-17,TNF-α.Enterococcus,Escherichia coli,PaCO_(2),and heart rate levels were significantly lower than those in the control group[CD4:0.32±0.06 vs.0.39±0.05,CD8:0.28±0.06 vs.0.34±0.05,IL-8(ng/L):16.64±2.63 vs.26.35±4.13,IL-17(ng/L):112.38±30.16 vs.207.75±42.23,TNF-α(ng/L):45.27±10.23 vs.61.26±14.29,Enterococcus(CFU/kg):63.6±5.6 vs.69.5±6.8,Escherichia coli(CFU/kg):65.8±6.4 vs.70.5±7.0,PaCO_(2)(mmHg):41.84±4.45 vs.56.18±5.37,heart rate(bpm):75.96±11.57 vs.91.57±12.68,all P<0.05].Conclusions Treatment with Lepidium seed combined with sodium-glucose cotransporter 2 inhibitor improved cardiopulmonary function,reduced inflammation,enhanced nutrition,and normalized gut flora in heart failure patients with lung infections.Our findings support integrating this combination into clinical guidelines for optimized management of these critically ill patients.