万古霉素联合骨搬移术治疗MRSA感染胫骨创伤性骨髓炎的效果及对血清TLR4、TNF-α和PCT水平的影响  

Efficacy of Vancomycine Combined with Bone Transfer Surgery in the Treatment of MRSA-Infected Traumatic Osteomyelitis of Tibia and Its Effects on Serum TLR4,TNF-αand PCT Levels

作　　者：陈立喜 陈元良 卓泽铭 王和杰[1] CHEN Lixi;CHEN Yuanliang;ZHUO Zeming;WANG Hejie(Dept.of Orthopedics,Haikou People’s Hospital Affiliated to Xiangya School of Medicine of Central South University,Haikou 570208,China;Dept.of Orthopedics,Haikou Orthopaedic and Diabetes Hospital,Haikou 570311,China)

机构地区：[1]中南大学湘雅医学院附属海口市人民医院骨科,海口570208 [2]海口市骨科与糖尿病医院骨科,海口570311

出　　处：《中国医院用药评价与分析》2024年第5期545-548,共4页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：海南省自然科学基金面上项目(No.820MS169)。

摘　　要：目的:探讨万古霉素联合骨搬移术治疗耐甲氧西林金黄色葡萄球菌(MRSA)感染胫骨创伤性骨髓炎的效果及对血清Toll样受体4(TLR4)、肿瘤坏死因子α(TNF-α)和降钙素原(PCT)水平的影响。方法:选取2020年4月至2022年4月中南大学湘雅医学院附属海口市人民医院收治的MRSA感染胫骨创伤性骨髓炎患者120例,利用计算机生成的随机数列分为对照组、观察一组和观察二组,每组40例。对照组患者采用常规手术治疗,观察一组患者采用骨搬移术治疗,观察二组患者采用万古霉素联合骨搬移术治疗。比较三组患者血清TLR4、TNF-α和PCT水平,观察两组患者的临床疗效、MRSA清除率、炎症指标[白细胞计数(WBC)、血清C反应蛋白(CRP)和白细胞介素6(IL-6)]及血液流变学指标(血浆黏度、全血黏度、纤维蛋白原、红细胞压积、红细胞沉降率和红细胞聚集指数)水平。结果:治疗2周后,观察二组患者TLR4、TNF-α和PCT水平低于对照组、观察一组,差异均有统计学意义(P<0.05)。治疗2周后,观察二组患者的总有效率、MRSA清除率分别为92.50%(37/40)、90.00%(36/40),高于对照组[80.00%(32/40)、75.00%(30/40)]和观察一组[85.00%(34/40)、80.00%(32/40)],差异均有统计学意义(P<0.05)。治疗2周后,观察二组患者WBC、CRP和IL-6水平,血浆黏度、全血黏度、纤维蛋白原、红细胞压积和红细胞沉降率低于对照组和观察一组,红细胞聚集指数高于对照组和观察一组,差异均有统计学意义(P<0.05)。结论:万古霉素联合骨搬移术治疗MRSA感染胫骨创伤性骨髓炎的疗效较好,能有效抑制患者血清TLR4、TNF-α和PCT水平的升高。OBJECTIVE:To probe into the efficacy of vancomycin combined with bone transfer surgery in the treatment of methicillin resistant Staphylococcus aureus(MRSA)infected traumatic osteomyelitis of tibia and its effects on serum Toll-like receptor 4(TLR4),tumor necrosis factorα(TNF-α)and procalcitonin(PCT).METHODS:A total of 120 patients with MRSA-infected traumatic osteomyelitis of tibia admitted into Haikou People’s Hospital Affiliated to Xiangya School of Medicine of Central South University from Apr.2020 to Apr.2022 were selected to be divided into control group,observation group 1 and observation group 2 by using computer-generated random number series,with 40 cases in each group.The control group was given conventional surgery,the observation group 1 was given bone transfer surgery,the observation group 2 was given vancomycin combined with bone transfer surgery.The serum TLR4,TNF-αand PCT levels were compared among three groups,the clinical efficacy,MRSA clearance rates,inflammatory indicators[white blood cell count(WBC),serum C reactive protein(CRP)and interleukin 6(IL-6)]and hemorheological indicators(plasma viscosity,whole blood viscosity,fibrinogen,hematokrit,erythrocyte sedimentation rate,erythrocyte aggregation index)of the three groups were observed.RESULTS:After 2 weeks of treatment,the TLR4,TNF-αand PCT levels of observation group 2 were lower than those of the control group and the observation group 1,with statistically significant differences(P<0.05).After 2 weeks of treatment,the total effective rate and MRSA clearance rate of observation group 2 were respectively 92.50%(37/40)and 90.00%(36/40),higher than those of the control group[80.00%(32/40)and 75.00%(30/40)]and the observation group 1[85.00%(34/40)and 80.00%(32/40)],with statistically significant differences(P<0.05).After 2 weeks of treatment,the WBC,CRP and IL-6 levels,plasma viscosity,whole blood viscosity,fibrinogen,hematokrit and erythrocyte sedimentation rate of observation group 2 were lower than those of the control group and the ob

关 键 词：万古霉素 骨搬移术 创伤性骨髓炎 耐甲氧西林金黄色葡萄球菌感染 

分 类 号：R978.1[医药卫生—药品]