基于白介素-6和降钙素原的头孢哌酮-舒巴坦钠联合高剂量替加环素对复杂性尿路感染疗效及安全性分析

Efficacy and safety analysis of cefoperazone-sulbactam sodium combined with high-dose tigecycline in the treatment of complicated urinary tract infections based on interleukin-6 and procalcitonin indexes

目的分析头孢哌酮-舒巴坦钠联合高剂量替加环素治疗复杂性尿路感染患者白介素(interleukin,IL)-6、降钙素原(procalcitonin,PCT)等指标及安全性。方法选取唐山职业技术学院附属医院2020年8月至2023年12月收治的156例耐碳青霉烯类鲍曼不动杆菌(carbapenem-resistant Acinetobacter baumannii,CRAB)致复杂性尿路感染患者作为回顾性研究对象。按替加环素给药剂量分为高剂量组及常规剂量组,各78例。高剂量组替加环素起始剂量200 mg,维持剂量100 mg,一日2次;常规剂量组替加环素起始剂量100 mg,维持剂量50 mg,一日2次。统计分析两组临床疗效、临床指标转阴时间、实验室指标[IL-6、IL-8、超敏C-反应蛋白(hypersensitive C-reactive protein,hs-CRP)及PCT]、尿培养转阴率、不良反应发生率、氧化应激指标[去甲肾上腺素(norepinephrine,NE)、谷胱甘肽过氧化物酶(glutathione peroxidase,GSH-Px)及血管紧张素(angiotensin,Ang)Ⅱ]水平及治疗满意度。结果高剂量组临床总有效率显著高于常规剂量组(P<0.05)。高剂量组临床症状消失时间、尿检白细胞转阴时间及退热时间均显著短于常规剂量组(P<0.05)。高剂量组治疗后IL-6、IL-8、hs-CRP及PCT水平显著低于常规剂量组(P<0.05)。高剂量组尿培养转阴率高于常规剂量组(23.36%vs12.82%,χ^(2)=3.431,P=0.009)。高剂量组不良反应总发生率高于常规剂量组(P>0.05),总治疗满意度明显高于对照组患者(96.15%vs 82.05%,P<0.05)。高剂量组治疗后NE、GSH-Px及AngⅡ水平显著优于常规剂量组(P<0.05)。结论高剂量替加环素联合头孢哌酮-舒巴坦钠对CRAB致复杂性尿路感染疗效显著,不良反应不显著高于常规剂量方案,兼顾安全性与有效性。

Objective To analyze the efficacy and safety of cefoperazone sulbactam sodium combined with high-dose tigecycline in the treatment of interleukin(IL)-6,procalcitonin(PCT)and other indicators in patients with complicated urinary tract infection.Methods A total of 156 patients with complicated urinary tract infection caused by carbapenemresistant Acinetobacter baumannii(CRAB)admitted to the Affiliated Hospital of Tangshan Vocational and Technical College from August 2020 to December 2023 were selected as retrospective study objects.The patients were divided into the high dose group and the routine dose group according to the dose of tigecycline,with 78 cases in each group.The initial dose of tigecycline in the high dose group was 200 mg,and the maintenance dose was 100 mg,twice a day.The initial dose of tigecycline in the routine dose group was 100 mg,and the maintenance dose was 50 mg,twice a day.The clinical efficacy,clinical indexes negative time,the laboratory indexe[IL-6,IL-8,hypersensitive C-reactive protein(hs-CRP)and PCT],the negative rate of urine culture,the incidence of adverse reactions and the oxidative stress indexes[noradrenaline(NE),glutathione peroxidase(GSH-PX),angiotensinogenⅡ(AngⅡ)]and treatment satisfaction were analyzed between the two groups.Results The total clinical effective rate of the high-dose group was significantly higher than that of the routine dose group(P<0.05).The time of clinical symptoms disappearing,the time of urine white blood cell turning negative,and the time of fever reduction in the high-dose group were significantly shorter than those in the routine dose group(P<0.05).The levels of IL-6,IL-8,hs CRP,and PCT in the high-dose group were significantly lower than those in the routine dose group after treatment(P<0.05).The negative conversion rate of urine culture in the high-dose group was higher than that in the routine dose group(23.36%vs 12.82%,χ^(2)=3.431,P=0.009).The total incidence of adverse reactions in the high-dose group was higher than that in the routine dose group(P>0.05),and the overall treatment satisfaction rate in the high-dose group was higher than that in the routine dose group(96.15%vs 82.05%,P<0.05).The levels of NE,GSH-Px,and AngⅡin the high-dose group were significantly higher than those in the routine dose group after treatment(P<0.05).Conclusions High-dose tigecycline combined with cefoperazone-sulbactam sodium has significant efficacy in the treatment of CRAB induced complicated urinary tract infection,and the adverse reactions are not significantly higher than that of the routine dose regimen,and is safe and effective.