胸腺肽α1注射液联合床边纤维支气管镜支气管肺泡灌洗术对老年重症肺炎患者外周血CD4~+/CD8~+水平及预后的影响
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摘要
目的探讨胸腺肽α1注射液联合床边纤维支气管镜支气管肺泡灌洗术对老年重症肺炎患者外周血CD4+/CD8+水平及预后的影响。方法选取2016年5月至2017年10月泸州市人民医院收治的82例重症肺炎患者临床资料进行回顾性分析,按照治疗方法将患者分为研究组和对照组,每组各41例。对照组采取床边纤维支气管镜支气管肺泡灌洗术,研究组在对照组基础上联合应用胸腺肽α1注射液。比较两组患者的临床疗效、体温恢复正常时间及住院时间、治疗前及疗程结束后血清炎性因子[降钙素原(PCT)、白细胞介素-2(IL-2)、IL-13]水平、免疫功能指标、APACHEⅡ评分。结果研究组患者总有效率(90. 24%)高于对照组(73. 17%)(P <0. 05);研究组患者体温恢复正常时间(5. 39±2. 26) d及住院时间(15. 51±3. 32) d短于对照组(P <0. 05);疗程结束后,研究组患者IL-2水平(73. 39±15. 08) pg/ml高于对照组,PCT(0. 62±0. 19) ng/L、IL-13(91. 01±8. 28) pg/ml水平低于对照组(P <0. 05);疗程结束后,研究组患者CD8~+水平低于对照组,CD3~+、CD4~+、CD4~+/CD8~+水平高于对照组(P <0. 05);治疗后1个月,研究组APACHEⅡ评分(8. 37±3. 65)分低于对照组(P <0. 05)。结论联合应用胸腺肽α1注射液及床边纤维支气管镜支气管肺泡灌洗术治疗老年重症肺炎,可提高治疗效果,缩短体温恢复时间及住院时间,改善血清炎性因子水平,调节机体免疫功能,且可改善老年患者健康状况,有利于提高近期预后效果。
Objective To explore the effect of thymosin α1 injection combined with bedside bronchioloalveolar lavage on peripheral blood levels of CD4~+/CD8~+ and prognosis in elderly patients with severe pneumonia. Methods From May 2016 to October 2017,82 patients with severe pneumonia in our center were retrospectively randomized into two groups. The control group( n = 41) underwent bedside bronchioloalveolar lavage while the study group( n = 41) was with thymosin α1 injection + bedside bronchioloalveolar lavage. The clinical efficacy,body temperature recovery time,hospital stay,serum inflammatory factors [procalcitonin( PCT),IL-2 and IL-13],immune function indexes and APACHE II scores before and after treatment were compared between both groups. Results The total effective rate of study group( 90. 24%) was higher than that of control group( 73. 17%)( P < 0. 05). Body temperature recovery time( 5. 39 ± 2. 26) d and hospitalization time( 15. 51 ± 3. 32) d in study group was shorter than in control group( P < 0. 05). After treatment,IL-2 level( 73. 39 ± 15. 08) pg/ml in study group was higher than in control group while PCT( 0. 62 ± 0. 19) ng/L and IL-13( 91. 01 ± 8. 28) pg/ml were lower than in control group( P < 0. 05). After treatment,CD8~+ levels in study group were lower than in control group,while levels of CD3~+,CD4~+,CD4~+/CD8~+ in study group were higher than in control group( P < 0. 05). At 1 mo posttreatment,APACHE II scores in study group( 8. 37 ± 3. 65) were lower than in control group( P < 0. 05). Conclusion Thymosin α1 injection combined with bedside bronchioloalveolar lavage in treating elderly patients with severe pneumonia can have positive clinical effect especially in improving CD4+/CD8+levels with better short-term prognosis.
Objective To explore the effect of thymosin α1 injection combined with bedside bronchioloalveolar lavage on peripheral blood levels of CD4~+/CD8~+ and prognosis in elderly patients with severe pneumonia. Methods From May 2016 to October 2017,82 patients with severe pneumonia in our center were retrospectively randomized into two groups. The control group( n = 41) underwent bedside bronchioloalveolar lavage while the study group( n = 41) was with thymosin α1 injection + bedside bronchioloalveolar lavage. The clinical efficacy,body temperature recovery time,hospital stay,serum inflammatory factors [procalcitonin( PCT),IL-2 and IL-13],immune function indexes and APACHE II scores before and after treatment were compared between both groups. Results The total effective rate of study group( 90. 24%) was higher than that of control group( 73. 17%)( P < 0. 05). Body temperature recovery time( 5. 39 ± 2. 26) d and hospitalization time( 15. 51 ± 3. 32) d in study group was shorter than in control group( P < 0. 05). After treatment,IL-2 level( 73. 39 ± 15. 08) pg/ml in study group was higher than in control group while PCT( 0. 62 ± 0. 19) ng/L and IL-13( 91. 01 ± 8. 28) pg/ml were lower than in control group( P < 0. 05). After treatment,CD8~+ levels in study group were lower than in control group,while levels of CD3~+,CD4~+,CD4~+/CD8~+ in study group were higher than in control group( P < 0. 05). At 1 mo posttreatment,APACHE II scores in study group( 8. 37 ± 3. 65) were lower than in control group( P < 0. 05). Conclusion Thymosin α1 injection combined with bedside bronchioloalveolar lavage in treating elderly patients with severe pneumonia can have positive clinical effect especially in improving CD4+/CD8+levels with better short-term prognosis.
引文
[1]陈志乐,王小智,梁萍,等.血必净注射液治疗重症肺炎并心力衰竭患者对心功能及相关细胞因子分析[J].临床和实验医学杂志,2017,16(15):1519-1522.
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[9] Tang L,Li Q,Bai J,et al. Severe pneumonia mortality in elderly patients is associated with downregulation of Toll-like receptors 2 and 4on monocytes[J]. Am J Med Sci,2014,347(1):34-41.
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[11]王志华,朱念,蔡金芳,等.支气管肺泡灌洗术在重症肺炎合并呼吸衰竭治疗中的作用[J].中国现代医学杂志,2012,22(31):86-88.
[12] Srinivasan R,Song Y,Wiener-Kronish J,et al. Plasminogen activation inhibitor concentrations in bronchoalveolar lavage fluid distinguishes ventilator-associated pneumonia from colonization in mechanically ventilated pediatric patients[J]. Pediatr Crit Care Med,2011,12(1):21-27.
[13]陈海英,张键.联合应用胸腺肽α1治疗老年重症肺炎的疗效观察[J].现代医学,2013,41(4):255-258.
[14] Shao C,Tian G,Huang Y,et al. Thymosin alpha-1-transformed Bifidobacterium,promotes T cell proliferation and maturation in mice by oral administration[J]. Int Immunopharmacol,2013,15(3):646-653.
[15]卢经伟,刘君君.胸腺肽α1辅助治疗老年重症肺炎的疗效观察[J].西南军医,2014,16(3):286-287.
[16]蔡泽波,杜江滨. IL-2与IL-13动态变化在儿童肺炎支原体肺炎发病中的作用及机制[J].中国妇幼保健,2018,33(8):1778-1780.
[2] Arai T,Tachibana K,Sugimoto C,et al. High-dose prednisolone after intravenous methylprednisolone improves prognosis of acute exacerbation in idiopathic interstitial pneumonias[J]. Respirology,2017,22(7):1363-1370.
[3]李川.支气管肺泡灌洗治疗老年重症肺炎合并呼吸衰竭患者的临床效果观察[J].世界临床医学,2016,10(14):28,31.
[4]倪楠,林琳.支气管肺泡灌洗治疗老年重症肺炎的临床疗效观察[J].中华老年多器官疾病杂志,2016,15(1):34-37.
[5] Weiss CH,Moazed F,Di Bardino D,et al. Bronchoalveolar lavage amylase is associated with risk factors for aspiration and predicts bacterial pneumonia[J]. Crit Care Med,2013,41(3):765-773.
[6]陈芙蓉,陈健君,徐仲卿.胸腺肽α1对重症肺炎患者Th17/Treg平衡的影响及其分子机制研究[J].医学分子生物学杂志,2016,13(4):212-217.
[7]陈智峰,黄绍华,刘志勇.头孢哌酮/舒巴坦联合胸腺肽α1治疗鲍曼不动杆菌重症肺炎的临床应用研究[J].中国感染控制杂志,2017,16(11):1048-1052.
[8]崔岩,高燕.支气管肺泡灌洗治疗老年重症肺炎合并呼吸衰竭的临床疗效[J].临床肺科杂志,2013,18(5):832-833.
[9] Tang L,Li Q,Bai J,et al. Severe pneumonia mortality in elderly patients is associated with downregulation of Toll-like receptors 2 and 4on monocytes[J]. Am J Med Sci,2014,347(1):34-41.
[10]余敏敏,简会琴.纤维支气管镜肺泡灌洗治疗小儿重症肺炎的疗效观察[J].现代实用医学,2013,25(11):1219-1220.
[11]王志华,朱念,蔡金芳,等.支气管肺泡灌洗术在重症肺炎合并呼吸衰竭治疗中的作用[J].中国现代医学杂志,2012,22(31):86-88.
[12] Srinivasan R,Song Y,Wiener-Kronish J,et al. Plasminogen activation inhibitor concentrations in bronchoalveolar lavage fluid distinguishes ventilator-associated pneumonia from colonization in mechanically ventilated pediatric patients[J]. Pediatr Crit Care Med,2011,12(1):21-27.
[13]陈海英,张键.联合应用胸腺肽α1治疗老年重症肺炎的疗效观察[J].现代医学,2013,41(4):255-258.
[14] Shao C,Tian G,Huang Y,et al. Thymosin alpha-1-transformed Bifidobacterium,promotes T cell proliferation and maturation in mice by oral administration[J]. Int Immunopharmacol,2013,15(3):646-653.
[15]卢经伟,刘君君.胸腺肽α1辅助治疗老年重症肺炎的疗效观察[J].西南军医,2014,16(3):286-287.
[16]蔡泽波,杜江滨. IL-2与IL-13动态变化在儿童肺炎支原体肺炎发病中的作用及机制[J].中国妇幼保健,2018,33(8):1778-1780.