抗菌药物联合免疫球蛋白治疗中晚期肝病并发感染的临床疗效  

Clinical effect of antibiotics combined with immunoglobulin on treatment of intermediate and advanced liver disease patients complicated with infection

作　　者：梁海军[1] 崔艳慧[2] 王燕平[1] 王新伟[1] 高海丽[1] 陈宝鑫[1] 杨道坤[1] LIANG Hai-jun;CUI Yan-hui;WANG Yan-ping;WANG Xin-wei;GAO Hai-li;CHEN Bao-xin;YANG Dao-kun(The First Affiliated Hospital,Xinxiang Medical College,Xinxiang,Henan 453100,China)

机构地区：[1]河南新乡医学院第一附属医院感染疾病科三病区,河南新乡453100 [2]河南新乡医学院第一附属医院肿瘤科,河南新乡453100

出　　处：《中华医院感染学杂志》2020年第1期86-90,共5页Chinese Journal of Nosocomiology

摘　　要：目的探讨抗菌药物联合免疫球蛋白治疗中晚期肝病并发感染患者的临床疗效。方法选取2013年10月-2016年10月河南新乡医学院第一附属医院收治的200例中晚期肝病并发感染患者,根据随机数字表,将200例中晚期肝病并发感染患者随机分成对照组和观察组,每组100例。对照组保肝、护肝治疗的同时应用第三代头孢类抗菌药物头孢噻肟钠进行抗感染治疗,观察组在对照组基础上联合免疫球蛋白治疗。治疗2周后,以Child-Pugh评分分层(分为Child-Pugh<10分及10~15分)观察治疗效果,分析患者炎症指标和T淋巴细胞亚群的水平变化。结果两组中Child-Pugh<10分患者的临床治疗有效率比较差异无统计学意义,Child-Pugh 10~15分患者,观察组的临床治疗有效率(83.3%)高于对照组的(67.7%)(P<0.05);治疗后两组患者炎症指标CRP、PCT、IL-6水平均较治疗前降低(P<0.05),其中Child-Pugh 10~15分患者,观察组CRP(7.15±1.52)mg/L、PCT(0.43±0.32)μg/L、IL-6(68.30±1.60)pg/ml均低于对照组(P<0.05);两组患者治疗后T淋巴细胞亚群CD4^+、CD4^+/CD8^+水平均降低,CD8^+、Treg水平均升高,与治疗前比较差异均有统计学意义(P<0.05),且观察组上述指标均优于对照组(P<0.05)。结论对于Child-Pugh<10分肝病患者,与单用抗菌药物相比,联合免疫球蛋白对抗感染有效率及炎症指标影响不大,但可提高机体免疫功能;对于Child-Pugh 10~15分肝病患者,抗菌药物联合免疫球蛋白不仅有效提高抗感染有效率,有效抑制炎症指标,且增加患者机体免疫功能,从而改善患者预后情况。OBJECTIVE To explore the clinical effect of antibiotics combined with immunoglobulin on treatment of intermediate and advanced liver disease patients complicated with infection. METHODS A total of 200 intermediate and advanced liver disease patients complicated with infection who were treated in the First Affiliated Hospital, Xinxiang Medical College from Oct 2013 to Oct 2016 were enrolled in the study and randomly divided into the control group and the observation group, with 100 cases in each group.The control group was treated with hepatic conservation therapy, hepatic protection therapy combined with third generation cephalosporin cefotaxime sodium, while the observation group was given additional immunoglobulin on basis of the treatment of the control group.The curative effects were observed based on the Child-Pugh score stratification(divided into Child-Pugh less than 10 points and 10-15 points) after the treatment for 2 weeks, and the levels of inflammatory indexes and T lymphocyte subsets were analyzed. RESULTS There was no significant difference in the effective rate of clinical treatment of the patients with Child-Pugh less than 10 points between the two groups.Among the patients with Child-Pugh ranging between 10 and 15 points, the effective rate of clinical treatment of the observation group was 83.3%, significantly higher than 67.7% of the control group(P<0.05).The levels of inflammatory indexes CRP, PCT and IL-6 of the two groups of patients were significantly lower after the treatment than before the treatment(P<0.05), the levels of CRP, PCT and IL-6 of the patients with Child-Pugh ranging between 10 and 15 points were respectively(7.15±1.52)mg/L,(0.43±0.32)μg/L and(68.30±1.60)pg/ml in the observation group, significantly lower than those in the control group(P<0.05).The levels of T lymphocyte subsets CD4^+ and CD4^+/CD8^+ of the two groups of patients were significantly reduced after the treatment, while the levels of CD8^+ and Treg were significantly elevated, as compared with those before th

关 键 词：中晚期肝病 感染 免疫球蛋白 T淋巴细胞亚群 

分 类 号：R575[医药卫生—消化系统]