胸腺肽联合异丙托溴铵治疗老年慢性阻塞性肺疾病合并重症肺炎的疗效  

Efficacy of thymosin combined with ipratropium bromide in treatmet of elderly patients with chronic obstructive pulmonary disease and severe pneumonia

作　　者：陈可 张威 杜龙玉 Chen Ke;Zhang Wei;Du Long-yu(Department of Intensive Care,Jinhua Central Hospital,Jinhua 321000,China)

机构地区：[1]金华市中心医院重症医学科,金华321000

出　　处：《中国药物应用与监测》2024年第6期699-703,共5页Chinese Journal of Drug Application and Monitoring

基　　金：浙江省科技计划项目(2024ZL1180)。

摘　　要：目的探讨胸腺肽与异丙托溴铵联合治疗老年慢性阻塞性肺疾病(COPD)合并重症肺炎的临床疗效。方法选取2022年4月至2024年1月在金华市中心医院就诊的老年COPD合并重症肺炎患者90例。随机数字表法均分为两组,两组患者均采用常规综合治疗,对照组加用异丙托溴铵治疗,观察组在对照组基础上加用胸腺肽治疗。两组患者治疗过程中各脱落2例,最终两组各43例完成观察。比较两组患者的疗效,治疗前后的肺部感染评分(CPIS)、急性生理与慢性健康评分(APACHEⅡ)、炎症相关指标[白细胞介素1受体拮抗剂(IL^(-1)Ra)、单核细胞Toll样受体4(TLR4)及金属蛋白酶组织抑制因子1(TIMP-1)]、肺功能指标[用力肺活量(FVC)、第1秒钟用力呼气容积与用力肺活量的比值(FEV1/FVC)、呼气峰值流速(PEF)]、免疫功能指标(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))以及不良反应情况。结果观察组治疗总有效率达86.05%,优于对照组的67.44%(χ²=4.170,P=0.041);治疗后,观察组和对照组的CPIS、APACHEⅡ、TIMP-1、TLR4[分别为(4.63±0.71)分、(12.33±2.07)分、(132.59±12.50)ng·L^(-1)、(44.32±7.15)%;(5.35±0.73)分、(15.30±2.58)分、(144.37±14.46)ng·L^(-1)、(53.23±8.19)%]均低于治疗前[分别为(8.15±1.82)分、(28.28±4.16)分、(183.48±27.32)ng·L^(-1)、(82.46±3.74)%;(8.32±1.63)分、(27.69±4.25)分、(188.15±26.47)ng·L^(-1)、(81.43±4.05)%],且观察组低于对照组(均P<0.05)。治疗后,观察组和对照组的IL^(-1)Ra、FVC、FEV1/FVC、PEF、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)[分别为(453.63±68.33)pg·mL^(-1)、(2.59±0.32)L、(48.34±5.35)%、(3.38±0.53)L·s^(-1)、(67.27±4.54)%、(40.59±3.50)%、(2.37±0.39);(387.27±51.54)pg·mL^(-1)、(2.25±0.28)L、(44.61±4.57)%、(2.86±0.45)L·s^(-1)、(63.63±5.73)%、(35.37±4.46)%、(2.02±0.35)]均高于治疗前[分别为(287.33±39.63)pg·mL^(-1)、(1.45±0.28)L、(37.23±5.78)%、(2.47±0.35)L·s^(-1)、(55.48±5.26)%、(31.15±3.47)%、(1.63±0.35)Objective To investigate the efficacy of thymosin combined with ipratropium bromide in treatment of elderly patients with chronic obstructive pulmonary disease(COPD)and severe pneumonia.Methods A total of 90 senior patients with severe pneumonia and COPD admitted to Jinhua Central Hospital from April 2022 to January 2024 were selected as the research subjects.According to random number table method,these patients were divided into two groups with 45 in each group.In addition to standard comprehensive care,ipratropium bromide was administered to the patients in the control group while ipratropium bromide and thymosin injection were used in the observation group.Two patients fell off during treatment in both groups and thus 43 patients completed the study in both.The curative effect,clinical pulmonary infection score(CPIS),scores of acute physiological and chronic health evaluationⅡ(APACHEⅡ),inflammatory indexes(interleukin-1 receptor antagonist(IL^(-1)Ra),monocyte Tolllike receptor 4(TLR4),tissue inhibitor of metalloproteinase-1(TIMP-1),pulmonary function indexes(forced vital capacity(FVC),forced expiratory volume in 1 second/FVC(FEV1/FVC),peak expiratory flow(PEF)),immune function indexes(CD3^(+),CD4^(+),CD4^(+)/CD8^(+))and adverse reactions in the two groups were compared before and after treatment.Results The total response rate in the observation group was 86.05%,which was significantly better than that of 67.44%in the control(χ²=4.170,P=0.041).After treatment,CPIS,APACHEⅡscore,TIMP-1 and TLR4 in the observation group and control group were(4.63±0.71)points,(12.33±2.07)points,(132.59±12.50)ng·L^(-1),(44.32±7.15)%and(5.35±0.73)points,(15.30±2.58)points,(144.37±14.46)ng·L^(-1),(53.23±8.19)%,lower than those before treatment((8.15±1.82)points,(28.28±4.16)points,(183.48±27.32)ng·L^(-1),(82.46±3.74)%;(8.32±1.63)points,(27.69±4.25)points,(188.15±26.47)ng·L^(-1),(81.43±4.05)%),and the observation group’s aforementioned indexes were lower than the control group’s(P<0.05).IL^(-1)Ra,FVC,F

关 键 词：胸腺肽 异丙托溴铵 慢性阻塞性肺疾病 重症肺炎 白细胞介素1受体拮抗剂 单核细胞Toll样受体4 金属蛋白酶组织抑制因子1 

分 类 号：R563.9[医药卫生—呼吸系统] R563.1[医药卫生—内科学]