盐酸氨溴索联合纤维支气管镜肺泡灌洗治疗重症肺炎的临床疗效及其对肺功能、外周血Th17细胞/Treg细胞的影响  

Clinical Effect of Ambroxol Hydrochloride Combined with Fiberoptic Bronchoscopic Alveolar Lavage on Severe Pneumonia and the Impact on Pulmonary Function and Peripheral Blood Th17 Cells/Treg Cells

作　　者：方荣[1] 韩丹[1] 诸炳骅[1] 张慰[2] FANG Rong;HAN Dan;ZHU Binghua;ZHANG Wei(Department of Emergency Medicine,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Medical Management Office,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203,China)

机构地区：[1]上海中医药大学附属曙光医院急诊科,上海市201203 [2]上海中医药大学附属曙光医院医务管理处,上海市201203

出　　处：《实用心脑肺血管病杂志》2019年第1期83-86,共4页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：目的观察盐酸氨溴索联合纤维支气管镜肺泡灌洗治疗重症肺炎的临床疗效,并分析其对肺功能、外周血Th17细胞/Treg细胞的影响。方法选取2016年5月—2018年5月上海中医药大学附属曙光医院收治的重症肺炎患者82例,采用随机数字表法分为对照组和观察组,每组41例。在常规治疗基础上,对照组患者给予盐酸氨溴索治疗,观察组患者在对照组基础上采用纤维支气管镜肺泡灌洗;两组患者均连续治疗1周。比较两组患者临床疗效,治疗前后动脉血气分析指标〔包括p H值、动脉血氧分压(Pa O_2)、动脉血二氧化碳分压(Pa CO_2)〕、肺功能指标〔包括用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、FEV1/FVC、最大呼气中段流量(MMF)、呼气峰值流速(PEF)〕、外周血Th17细胞、Treg细胞占单个核细胞百分比及其相关细胞因子〔包括白介素6(IL-6)、白介素10(IL-10)、白介素17(IL-17)〕,并观察两组患者治疗期间不良反应/并发症发生情况。结果 (1)观察组患者临床疗效优于对照组(P<0.05)。(2)治疗前两组患者pH值、PaO_2及PaCO_2比较,差异无统计学意义(P>0.05);治疗后观察组患者pH值、PaO_2高于对照组,PaCO_2低于对照组(P<0.05)。(3)治疗前两组患者FVC、FEV1、FEV1/FVC、MMF、PEF比较,差异无统计学意义(P>0.05);治疗后观察组患者FVC、FEV1、MMF大于对照组,FEV1/FVC高于对照组,PEF快于对照组(P<0.05)。(4)治疗前两组患者外周血Th17细胞、Treg细胞占单个核细胞百分比及血清IL-6、IL-10、IL-17水平比较,差异无统计学意义(P>0.05);治疗后观察组患者外周血Th17细胞占单个核细胞百分比及血清IL-6、IL-17水平低于对照组,外周血Treg细胞占单个核细胞百分比及血清IL-10水平高于对照组(P<0.05)。(5)治疗期间两组患者均未发生明显不良反应;观察组患者治疗期间2例发生心律失常。结论盐酸氨溴索联合纤维支气管镜肺泡灌洗治疗重症肺炎的临床�Objective To observe the clinical effect of ambroxol hydrochloride combined with fiberoptic bronchoscopic alveolar lavage on severe pneumonia,to investigate the impact on pulmonary function and peripheral blood Th17/Treg cells. Methods A total of 82 patients with severe pneumonia were selected in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from May 2016 to May 2018,and they were divided into control group and observation group according to random number table,each with 41 cases. Based on conventional treatment,patients in control group received ambroxol hydrochloride,while patients in observation group received ambroxol hydrochloride combined with fiberoptic bronchoscopic alveolar lavage;both groups continuously treated for 1 week. Clinical effect,arterial blood-gas analysis index(including pH value,PaO2 and PaCO2),index of pulmonary function(including FVC,FEV1,FEV1/FVC,MMF and PEF),peripheral blood percentage of Th17 and Treg in mononuclear cells,and Th17/Treg cells related cytokines(including IL-6,IL-10 and IL-17)before and after treatment were compared between the two groups,and incidence of adverse reactions/ complications during treatment was observed. Results (1)Clinical effect in observation group was statistically significantly better than that in control group(P<0.05).(2)No statistically significant difference of pH value,PaO2 or PaCO2 was found between the two groups before treatment(P>0.05);after treatment,pH value and PaO2 in observation group were statistically significantly higher than those in control group,while PaCO2 in observation group was statistically significantly lower than that in control group(P<0.05).(3)No statistically significant difference of FVC,FEV1,FEV1/FVC,MMF or PEF was found between the two groups before treatment(P>0.05);after treatment,FVC,FEV1 and MMF in observation group were statistically significantly greater than those in control group,FEV1/FVC in observation group was statistically significantly higher than that in control group,me

关 键 词：肺炎 氨溴索 支气管镜肺泡灌洗 肺功能 TH17细胞 TREG细胞 

分 类 号：R563.1[医药卫生—呼吸系统]