不同剂量氟康唑对慢性阻塞性肺疾病急性加重患者肺部真菌感染预防作用及其对免疫功能影响的对比研究  

Preventive Effect of Different Doses of Fluconazole on Pulmonary Fungal Infection and the Impact on Immune Function in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease:a Comparative Study

作　　者：李莉[1] 张彦红[1] 赵自冰 刘红霞[1] 王桂东 LI Li;ZHANG Yanhong;ZHAO Zibing;LIU Hongxia;WANG Guidong(The Traditional Chinese Medicine Hospital of Handan,Handan 056002,China)

机构地区：[1]河北省邯郸市中医院

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

摘　　要：目的比较不同剂量氟康唑对慢性阻塞性肺疾病急性加重(AECOPD)患者肺部真菌感染的预防作用及其对免疫功能的影响。方法选取2015-2016年邯郸市中医院收治的AECOPD患者120例,采用随机数字表法分为对照组、小剂量组、大剂量组,每组40例。3组患者均按照AECOPD临床路径进行治疗,小剂量组患者给予氟康唑0.2 g静脉滴注,1次/d;大剂量组患者给予氟康唑0.2 g静脉滴注,2次/d;3组患者均连续治疗2周。比较3组患者治疗期间肺部真菌感染及耐药菌株情况,治疗前后体液免疫功能指标〔包括免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)〕及细胞免疫功能指标(包括CD3+细胞分数、CD4+细胞分数、CD8+细胞分数及CD4+/CD8+细胞比值);并观察3组患者治疗期间不良反应发生情况。结果(1)小剂量组和大剂量组患者治疗期间肺部真菌感染发生率低于对照组(P<0.05)。3组患者均未出现耐药菌株。(2)治疗前3组患者IgA、IgG、IgM水平比较,差异无统计学意义(P>0.05);治疗后小剂量组和大剂量组患者IgA、IgG、IgM水平高于对照组(P<0.05)。(3)治疗前3组患者CD3+细胞分数、CD4+细胞分数、CD8+细胞分数及CD4+/CD8+细胞比值比较,差异无统计学意义(P>0.05);治疗后小剂量组和大剂量组患者CD3+细胞分数、CD4+细胞分数及CD4+/CD8+细胞比值高于对照组,CD8+细胞分数低于对照组(P<0.05)。(4)治疗期间3组患者均未出现明显肝肾功能损伤、皮疹、胃肠道不适等不良反应。结论小剂量(0.2 g/次、1次/d)和大剂量(0.2 g/次、2次/d)氟康唑对AECOPD患者肺部真菌感染的预防作用及免疫功能的改善效果相似,且安全性均较高。Objective To compare the preventive effect of different doses of fluconazole on pulmonary fungal infection and the impact on immune function in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 120 patients with AECOPD were selected in the Traditional Chinese Medicine Hospital of Handan from2015 to 2016,and they were divided into control group,low-dose group and high-dose group accord to random number table method,with 40 cases in each group. Patients in the three groups were treated according to the clinical pathway of AECOPD,moreover patients in low-dose group were given intravenous drip of low-dose fluconazole(0.2 g per time,once per day),while patients in high-dose group were given intravenous drip of high-dose fluconazole(0.2 g per time,twice per day);all of the three groups continuously treated for 2 weeks. Incidence of pulmonary fungal infection and distribution of drug-resistant strains,humoral immune function indicators(including IgA,IgG and IgM)and cellular immune function indicators(including CD3+ cell percentage,CD4+ cell percentage,CD8+ cell percentage and CD4+/CD8+ cell ratio)before and after treatment were compared in the three groups,and incidence of adverse reactions was observed during treatment. Results(1)Compared with control group,incidence of pulmonary fungal infection was statistically significantly lower in low-dose group and high-dose group,respectively(P<0.05). No one in three groups occurred resistant strains.(2)There was no statistically significant difference of IgA,IgG or IgM in the three groups before treatment(P>0.05),while IgA,IgG and IgM in low-dose group and high-dose group were statistically significantly higher than those in control group after treatment(P<0.05).(3)There was no statistically significant differences of CD3+ cell percentage,CD4+ cell percentage,CD8+ cell percentage or CD4+/CD8+ cell ratio in the three groups before treatment(P>0.05);after treatment,CD3+ cell percentage,CD4+ cell percentage and CD4+/CD8+ cell rat

关 键 词：慢性阻塞性肺疾病 急性加重 氟康唑 真菌感染 免疫功能 疗效比较研究 

分 类 号：R563.9[医药卫生—呼吸系统]