抗感染联合纤维支气管镜吸痰治疗对重症肺炎患者症状缓解及炎性反应的影响

Effect of anti infection combined with fiexible bronchofiberscope aspiration of sputum therapy on symptoms and inflammatory response in patients with severe pulmonary infection

目的探讨抗感染联合纤维支气管镜吸痰治疗对重症肺炎患者肺功能和炎症状态的影响及可能作用机制。方法选取2015年1月至2016年4月在新乡市第一人民医院呼吸科住院治疗的重症肺炎患者104例,根据治疗方法分为研究组和对照组,每组52例,对照组患者进行常规抗感染治疗,研究组患者在常规抗感染治疗基础上联合纤维支气管镜吸痰。比较2组患者治疗后的肺功能指标、炎性相关因子、病情严重程度相关指标;Western blot法检测Toll样受体2/转录因子蛋白κB(TLR2/NF-κB)和氨基末端激酶/应激活化蛋白激酶(JNK/SAPK)信号通路下游分子的蛋白表达情况。结果研究组患者治疗后1 s用力呼气容积、最大通气量、最大呼气中期流量、功能残气量、肺总量均显著高于对照组(P<0.05);研究组患者治疗后血清血小板激活因子、巨噬细胞炎症蛋白-1α、可溶性髓细胞触发受体-1、降钙素原水平均显著低于对照组,脂联素水平显著高于对照组(P<0.05);研究组患者治疗后血清血管紧张素转化酶、血清一氧化氮、血管内皮素-1、人肺表面活性蛋白、人高迁移率族蛋白水平显著低于对照组,Clara细胞分泌蛋白、胆碱酯酶水平显著高于对照组(P<0.05);研究组患者治疗后TLR2、NF-κB、JNK、SAPK表达水平均显著低于对照组(P<0.05)。结论抗感染联合纤维支气管镜吸痰治疗能够有效改善重症肺炎患者的症状,抑制炎症反应,其机制可能与下调TLR2/NF-κB和JNK/SAPK信号通路表达有关。

Objective To investigate the effect of anti infection combined with fiexible bronchofiberscope aspiration of sputum therapy on the pulmonary function and inflammatory status in patients with severe pulmonary infection and explore the possible mechanism. Methods One hundred and four patients with severe pneumonia in Department of Respirtatorty of the First People's Hospital of Xinxiang from January 2015 to April 2016 were selected and divided into study group and control group,with 52 patients in each group. The patients in control group were given conventional anti infective therapy; based on this,the patients in study group were given fiexible bronchofiberscope aspiration of sputum therapy. The pulmonary function indicators,inflammation related factors and disease severity related indicators of patients after treatment were compared between the two groups. The expression of Toll-like receptors 2/nuclear factor-kappa B( TLR2/NF-κB) and c-Jun N-terminal kinase/stress-activated protein kinases( JNK/SAPK) were detected by Western blot. Results After treatment,the levels of forced expiratory volume in one second,maximum minute ventilation,maximum midexpiratory flow,functional residual capacity and total lung capacity of patients in the study group were significantly higher than those in the control group( P < 0. 05). The levels of serum platelet activating factor,macrophage inflammatory protein-1α,human soluble triggering receptor expresses on myeloid cells-1 and procalcitonin of patients in the study group were significantly lower than those in the control group( P < 0. 05); but adiponectin levels were significantly higher than those in the control group( P < 0. 05). The serum levels of angiotensin conver-ting enzyme,nitric oxide,endothelin-1,human pulmonary surfatcant-associated protein A and human high-mobility group box-1in the study group were significantly lower than those in the control group( P < 0. 05); but the Clara cell secretory 16-kd protein and choline esterase levels were significantly higher than those in the control group( P < 0. 05). The expression of TLR2,NF-κB,JNK and SAPK protein in study group were significantly lower than those in the control group( P < 0. 05). Conclusion Anti infection combined with fiexible bronchofiberscope aspiration of sputum can improve the symptoms of patients with severe pneumonia and inhibit the inflammatory response,which may be related to the down-regulation of the expression of NF-κB and JNK / SAPK signaling pathway.