中性粒细胞弹性蛋白酶抑制剂治疗艾滋病合并急性肺损伤/急性呼吸窘迫综合征的疗效分析  

The efficacy of neutrophil elastase inhibitors in the treatment of AIDS patients co-infected with acute lung injury/acute respiratory distress syndrome

作　　者：张乐 李翔 李海雯 张艳 罗季 沈含章 张洪涛 张开义 ZHANG Le;LI Xiang;LI Haiwen;ZHANG Yan;LUO Ji;SHEN Hanzhang;ZHANG Hongtao;ZHANG Kaiyi(The Third People's Hospital of Kunming(Yunnan Provincial Clinical Medical Centre for Infectious Diseases),Kunming 650041,Yunnan,China;People's Hospital of Nujiang Lisu Autonomous Prefecture,Nujiang 673299,Yunnan,China)

机构地区：[1]昆明市第三人民医院(云南省传染性疾病临床医学中心),昆明650041 [2]云南省怒江傈僳族自治州人民医院,云南怒江673299

出　　处：《中国艾滋病性病》2024年第8期815-819,共5页Chinese Journal of Aids & STD

基　　金：昆明市卫生科技人才培养“千”工程后备人选[2023-SW(后备)-76];云南省教育厅科学研究基金项目[2024 J0872]。

摘　　要：目的本研究旨在探讨中性粒细胞弹性蛋白酶抑制剂(NEI)在治疗艾滋病合并急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)中的效果。方法本研究采用回顾性病例对照研究设计,选取昆明市第三人民医院2022年1月1日至2023年12月31日期间收治的艾滋病合并ALI/ARDS患者83例为研究对象,采用SPSS 26.0软件进行t检验、χ^(2)检验,使用Pearson相关系数分析观察指标之间的相关性。结果共选取83例患者依据有无使用NEI进行分组,仅接受常规治疗(常规组)60例,在常规治疗基础上加用NEI(NEI组)23例,两组病例基线资料比较差异无统计学意义(P>0.05);治疗后观察指标对比分析,NEI组氧合指数(PaO2/FiO2)[(185.8±34.7)mmHg]、IL-10[(28.7±7.5)pg/mL]高于常规组[(167.3±31.2)mmHg、(14.9±3.5)pg/mL];NEI组白细胞计数[(9.2±2.2)×10^(9)/L]、C反应蛋白[(9.7±3.5)mg/L]、IL-6[(32.5±9.8)pg/mL]、IL-8[(29.0±7.1)pg/mL]低于常规组[(10.5±2.3)×10^(9)/L、(13.2±4.1)mg/L、(45.6±12.3)pg/m、(35.3±8.4)pg/mL];治疗预后影响对比分析,NEI组患者平均非机械通气天数(10.8±3.1)d,高于常规组(8.7±2.8)d(P<0.01);NEI组28 d病死率13.0%低于常规组21.7%(P=0.03);Pearson相关系数分析,白细胞计数、C反应蛋白、IL-6和IL-10与28 d病死率均呈正相关,其中IL-10与28 d病死率的相关系数为0.24。结论NEI能有效改善艾滋病合并ALI/ARDS患者的氧合情况、降低炎症指标,并提高抗炎因子水平,增加非机械通气天数及降低28 d病死率。Objective This study aimed to investigate the effectiveness of neutrophil elastase inhibitors(NEIs)in treating acute lung injury(ALI)/acute respiratory distress syndrome(ARDS)in patients with AIDS.Methods A retrospective case-control study was conducted,and 83 patients co-infected with AIDS and ALI/ARDS admitted to the Kunming Third People's Hospital between January 1,2022,and December 31,2023,were included.The patients were divided into two groups:the conventional group(n=60),receiving routine treatment,and the NEI group(n=23),receiving NEI in addition to routine treatment.Data were analyzed using t-tests,chi-square tests,and Pearson correlation coefficient analysis using SPSS 26.0.Results Among the 83 patients,60 received routine treatment only(conventional group)and 23 received NEI in addition to routine treatment(NEI group).No significant differences were observed in the baseline characteristics between the two groups(P>0.05).After treatment,the NEI group showed a higher oxygenation index(PaO_2/FiO_2,185.8±34.7 mm Hg)and IL-10(28.7±7.5 pg/m L)compared with the conventional group(167.3±31.2 mm Hg,14.9±3.5 pg/m L).The NEI group had a lower white blood cell count(9.2±2.2×10^(9)/L),C-reactive protein(9.7±3.5 mg/L),IL-6(32.5±9.8 pg/m L),and IL-8(29.0±7.1 pg/m L)compared with the conventional group(10.5±2.3×10^(9)/L,13.2±4.1 mg/L,45.6±12.3 pg/m L,and 35.3±8.4 pg/m L).In terms of treatment outcomes,the NEI group had a higher average duration of non-mechanical ventilation(10.8±3.1 days)compared with the conventional group(8.7±2.8 days)(P<0.01).The 28-day mortality rate was lower in the NEI group(13.0%)compared with the conventional group(21.7%)(P=0.03).Pearson's correlation coefficient analysis showed that white blood cell count,C-reactive protein,IL-6,and IL-10 were positively correlated with 28-day mortality,with IL-10 having a correlation coefficient of 0.24.Conclusions NEI can effectively improve oxygenation,reduce inflammatory markers,increase anti-inflammatory factors,increase the duration of no

关 键 词：艾滋病 中性粒细胞弹性蛋白酶抑制剂 急性肺损伤/急性呼吸窘迫综合征 

分 类 号：R512.91[医药卫生—内科学]