莫西沙星左氧氟沙星序贯给药...者呼吸功能微炎症的影响研究_王超.pdf

挛,使痰液顺利排出,改善患儿缺氧症状,促进其临床转归7。由于病原菌感染,患儿机体炎症因子水平升高,CRP 是肝细胞产生的急性时相蛋白,其水平变化与机体发生损伤、感染相关8。PCT 是降钙素的前体物由肝脏产生,当机体受细菌、真菌感染时,其水平显著上升,能反映炎症的水平。氨溴索能增强抗菌药物气道浓度,对细菌或病毒滋生有抑制作用;布地奈德可与呼吸道上皮部位的糖皮质激素受体结合,可阻断炎性介质、过敏活性递质释放,发挥快速的抗炎效应,抑制呼吸道毛细血管通透性,两者联用能够有效改善局部炎症9。IgA、IgM、IgG 与机体体液免疫相关,IgM 在感染后出现较早,具有溶血溶菌的效果;IgA 是主要存在于呼吸道分泌液、唾液等外分泌液中,能够抑制病原菌的黏附的作用;IgG 是由淋巴结及脾脏产生,在感染后出现时间较晚,但亲和力高、作用时间长,三者在中和毒素、抗感染过程中均发挥重要作用。本研究显示,观察组 CRP、PCT 水平均低于对照组,观察组 IgA、IgM、IgG水平高于对照组,提示联合治疗对患者患儿炎症因子水平、免疫功能的改善效果优于单一布地奈德雾化,有利于其病情恢复。治疗期间,两组不良反应发生率分别为 9.68%、7.53%,且比较无明显差异,提示布地奈德雾化联合氨溴索治疗不会增加患儿的不良反应发生率。综上,布地奈德雾化联合氨溴索治疗小儿支气管肺炎疗效优于单一布地奈德雾化,对患儿临床症状、炎症因子、免疫功能的改善效果优于单一布地奈德雾化,有利于其病情恢复,且具有一定安全性。【参考文献】1 Chen LJ,Li JM,Zhang WD,et al.LncRNA NEAT1 activates MyD88/NF-B pathway in bronchopneumonia through targe-ting miR-155-5pJ.Autoimmunity,2021,54(2):104-113.2 Ye J,Ye H,Wang M,Zhao Y.Total serum IL-6 and TNF-C levels in children with bronchopneumonia following treatment with methylprednisolone in combination with azithromycinJ.Am Transl Res,2021,13(8):9458-9464.3 雷丽,樊扬,吕洁,等.布地奈德联合氨溴索治疗小儿支气管肺炎的疗效及对相关炎症指标,免疫因子的影响J.北华大学学报:自然科学版,2020,21(3):366-370.4 Ye J,Ye H,Wang M,et al.Total serum IL-6 and TNF-C levels in children with bronchopneumonia following treatment with methylprednisolone in combination with azithromycinJ.Am Transl Res,2021,13(8):9458-9464.5 Zhao D,Chen M,Shi K,et al.A long short-term memory-fully connected(LSTM-FC)neural network for predicting the incidence of bronchopneumonia in childrenJ.Environ Sci Pollut Res Int,2021,28(40):56892-56905.6 李艳华,史鸽,史笑敏.脾多肽注射液联合布地奈德雾化吸入治疗支气管肺炎的效果及对免疫功能的影响J.广东医学,2020,41(23):2398-2401.7 范旭升,陈杰华.氨溴索联合布地奈德混悬液雾化吸入治疗新生儿肺炎疗效观察J.海南医学,2020,31(11):1415-1418.8陈庆元,朱杰军,何文丽.支气管肺炎患儿血清 LDH3,CRP 及免疫功能变化的临床意义J.标记免疫分析与临床,2020,27(8):1390-1394.9 王玲莉,瞿色华,王德志.布地奈德、异丙托溴铵联合沙丁胺醇雾化吸入治疗小儿支气管肺炎的效果及对 TGF-1、CRP 的影响J.湖南师范大学学报(医学版),2021,18(4):230-233.【文章编号】1006-6233(2023)04-0685-05莫西沙星左氧氟沙星序贯给药对老年重症慢性阻塞性肺疾病急性加重期患者呼吸功能微炎症的影响研究王超1,陈晓君2,宋晓莉1,郭帅1(1.海南省三亚市中心医院/海南省第三人民医院药学部,海南三亚 5720002.海南省三亚市人民医院药学部,海南三亚 572000)【摘要】目的:研究莫西沙星、左氧氟沙星序贯给药对老年重症慢性阻塞性肺疾病急性加重期(AECOPD)患者呼吸功能、微炎症的影响。方法:选取 2019 年 3 月至 2022 年 3 月期间于我院接受治疗的老年重症 AECOPD 患者 150 例,将其应用简单随机法分为 A 组和 B 组、C 组,每组各 50 例,A 组给予莫西沙星治疗,B 组给予左氧氟沙星治疗,C 组给予莫西沙星、左氧氟沙星序贯给药。对比三组患者治疗 1 周后呼吸功能第 1 秒用力呼气的容积占预计值的百分比(fev1%pred)、第 1 秒钟用力呼吸容积586 第 29 卷 第 4 期2023 年 4 月 河 北 医 学HEBEI MEDICINE Vol.29,No.4Apr.,2023 【基金项目】海南省卫生健康行业科研项目,(编号:21A200397)(FEV1)/用力肺活量(FVC),比较分析三组治疗前后血清微炎症细胞间黏附分子(ICAM)-1、干扰素 可诱导的蛋白-10(IP-10)、免疫功能血浆可溶性髓样细胞触发受体-1(sTREM-1)、外周血 CD4+/CD8+变化情况,对比三组药物不良反应发生差异。结果:治疗 1 周后,三组 fev1%pred、FEV1/FVC、外周血 CD4+/CD8+上升,血清 ICAM-1、IP-10、血浆 sTREM-1 下降,差异有统计学意义(P0.05)。相同时间三组对比,A 组 fev1%pred、FEV1/FVC、外周血 CD4+/CD8+较 B 组更高,血清 ICAM-1、IP-10、血浆sTREM-1 更低,C 组较 A、B 两组 fev1%pred、FEV1/FVC、外周血 CD4+/CD8+更高,血清 ICAM-1、IP-10、血浆 sTREM-1 更低,差异有统计学意义(P0.05)。C 组静脉炎发生率较 A、B 两组更低,差异有统计学意义(P0.05)。结论:莫西沙星、左氧氟沙星序贯给药可缓解 AECOPD 患者微炎症反应,改善其肺功能及免疫指标,还可有效预防静脉炎发生。【关键词】莫西沙星;左氧氟沙星;序贯给药;老年重症慢性阻塞性肺疾病急性加重期;呼吸功能;微炎症【文献标识码】A 【doi】10.3969/j.issn.1006-6233.2023.04.032Effects of Sequential Administration of Moxifloxacin and Levofloxacin on Respiratory Function and Microinflammation in Elderly Patients with Severe AECOPDWANG Chao,et al(Sanya Central Hospital/Hainan Third Peoples Hospital,Hainan Sanya 572000,China)【Abstract】Objective:To study the effects of sequential administration of moxifloxacin and levofloxacin on respiratory function and microinflammation in elderly patients with severe acute exacerbation of chronic ob-structive pulmonary disease(AECOPD).Methods:150 elderly patients with severe AECOPD treated in our hospital from March 2019 to March 2022 were selected and divided into group A,B and C by simple random sampling method,with 50 cases in each group.Group A was given moxifloxacin,group B was given levofloxa-cin,and group C was given moxifloxacin and levofloxacin administered sequentially.The respiratory function indicators forced expiratory volume in the first second as a percentage of the predicted value(fev1%pred)and forced expiratory volume in the first second(FEV1)/forced vital capacity(FVC)were compared among the three groups after 1 week of treatment,and the changes of serum microinflammation intercellular cell ad-hesion molecule(ICAM)-1,interferon gamma-inducible protein-10(IP-10)and immune function plas-ma-soluble triggering receptor expressed on myeloid cells-1(sTREM-1),peripheral blood CD4+/CD8+were compared and analyzed before and after treatment.The differences in occurrence of adverse drug reac-tions among the three groups were compared.Results:After 1 week of treatment,fev1%pred,FEV1/FVC and peripheral blood CD4+/CD8+were increased while serum ICAM-1,IP-10 and plasma sTREM-1 were decreased in the three groups the difference was statistically significant(P0.05).Compared at the soone time the fev1%pred,FEV1/FVC and peripheral blood CD4+/CD8+in group A were higher while serum ICAM-1,IP-10 and plasma sTREM-1 were lower than those in group B,and fev1%pred,FEV1/FVC and periph-eral blood CD4+/CD8+were higher while serum ICAM-1,IP-10 and plasma sTREM-1 were lower in