急性加重期慢性阻塞性肺疾病患者肺功能损伤细胞因子的变化与莫西沙星治疗疗效分析  

Clinical research of cytokines changes of pulmonary function injury in AECOPD patients and moxifloxacin therapy

作　　者：侯守强[1] 荣陶 杨秀军[1] 孙浩[1] 张亚[1] 

机构地区：[1]江苏省洪泽县人民医院呼吸内科,江苏洪泽县223100

出　　处：《中华医院感染学杂志》2016年第19期4425-4427,共3页Chinese Journal of Nosocomiology

基　　金：江苏省教委自然科学基金资助项目(JW970082)

摘　　要：目的探讨急性加重期慢性阻塞性肺疾病(AECOPD)不同程度肺功能损伤患者的感染及TNF-α细胞因子变化与应用莫西沙星的治疗效果,为预防AECOPD患者感染提供参考。方法将医院于2015年1-11月收治140例AECOPD患者作为研究对象,收集其痰液,分析感染病原菌的分布,按照其入院的先后分为观察组和对照组,各70例;对照组患者给予支气管扩张剂、糖皮质激素及抗感染治疗等常规治疗,观察组患者则在对照组基础上加莫西沙星治疗,对比治疗前后两组患者IL-8、TNF-α水平及治疗后临床疗效、细菌清除率、不良反应发生率及相关预后指标。结果 AECOPD患者的痰液中共分离出129株病原菌,其中革兰阴性菌占65.11%,革兰阳性菌占27.91%,真菌占6.98%;两组患者IL-8及TNF-α水平随着肺功能损伤严重增加而不断升高,治疗后均有所下降,但观察组下降幅度明显大于对照组,差异有统计学意义(P<0.05);观察组患者总有效率、细菌清除率、FEV1增加率、呼吸困难改善率等均高于对照组,差异有统计学意义(P<0.05);两组患者不良反应发生率比较差异无统计学意义。结论 AECOPD患者的病原菌分布主要以革兰阴性菌和革兰阳性菌为主,其IL-8及TNF-α水平随着肺功能损伤严重增加而升高,常规治疗的基础加莫西沙星治疗,能够显著提高其临床疗效和细菌清除率。OBJECTIVE To research the infection of acute exacerbation of chronic obstructive pulmonary disease（AECOPD）patients with different degrees of pulmonary function injury,change of TNF-αand the effect of moxifloxacin,so as to provide reference for the prevention of infection in patients with AECOPD.METHODS A total of140 cases of AECOPD patients admitted to our hospital from Jan.2015 to Nov.2015 were selected as the research objects,whose sputum were collected and got analyzed for the distribution of pathogenic bacteria.Then according to the order of admission,they were divided into the observation group and the control group,each group 70 cases.The control group was given routine treatment like bronchodilators,glucocorticoid and anti-infective therapy.On this basis,the observation group was given moxifloxacin treatment.The levels of IL-8and TNF-αbetween the two groups were compared and the clinical efficacy,bacterial clearance rate and incidence of adverse reactions of the two groups were under comparison as well.RESULTS A total of 129 strains of pathogens were isolated from the sputum of patients with AECOPD,among which gram-negative bacteria 65.11%,gram-positive bacteria 27.91%,and fungi 6.98%;The level of IL-8and TNF-αincreased continually as the severe condition of lung function in two groups,which decreased in certain way after treatment but observation group decreased much more than control group（P〈0.05）.The total efficacy rate,bacterial clearance rate,FEV1 increasing rate and improving of difficult breathing were all significantly higher than control group（P〈0.05）;And incidence of adverse reactions of the two groups had no significant different.CONCLUSION The pathogenic bacteria distribution of AECOPD patients are mainly gram negative bacilli and gram positive bacteria,and the IL-8and TNF-levels increase with the severity of lung injury.Moxifloxacin combined with routine treatment can significantly improve the clinical curative effect and bacteria clearance rate.

关 键 词：急性加重期慢性阻塞性肺疾病 肺功能损伤 细胞因子 莫西沙星 

分 类 号：R563[医药卫生—呼吸系统]