甲泼尼龙治疗重症社区获得性肺炎的疗效及其对血清炎症因子水平的影响
| 作者: |
1申芳芳,
1王廷海,
1李可欣,
1王龙,
1钱雪梅
1 北京朝阳急诊抢救中心，北京 100122 |
| 通讯: |
申芳芳
Email: hbxms2008@163.com |
| DOI: | 10.3978/j.issn.2095-6959.2020.07.016 |
| 基金: | 北京市科学技术委员会科研计划项目(D151100004123009)。 |
摘要
目的：探讨甲泼尼龙治疗重症社区获得性肺炎(severe community acquired pneumonia，SCAP)的疗效及其对血清炎症因子水平的影响。方法：将2014年2月至2018年2月北京朝阳急诊抢救中心收治的80例SCAP患者随机分为2组，对照组(40例)采用抗感染等基础治疗，观察组(40例)在对照组基础上增加甲泼尼龙治疗，均治疗1周。观察两组疗效、临床症状消失时间以及治疗前后血气指标和炎症因子的变化。结果：观察组治疗有效率高于对照组(90.00% vs 70.00%，P<0.05)；观察组发热[(2.01±0.19) d vs (3.14±0.25) d]，喘息[(3.26±0.39) d vs (5.24±0.69) d]，咳嗽咳痰[(5.13±0.92) d vs (6.35±0.25) d]，肺湿啰音[(3.76±0.52) d vs (5.37±0.63) d]持续时间短于对照组，差异有统计学意义(P<0.05)。两组治疗后动脉血氧饱和度(arterial oxygen saturation，O2sat)、动脉血氧分压((arterial blood carbon dioxide partial pressure，PO2)、动脉血pH值增高；动脉血二氧化碳分压(arterial blood carbon dioxide partial pressure，PCO2)、血清肿瘤坏死因子-α(tumor necrosis factor-α，TNF-α)、白介素-8(interleukin-8，IL-8)、超敏C反应蛋白(hypersensitive C-reactive protein，hs-CRP)水平降低，差异有统计学意义(P<0.05)。观察组治疗后PCO2[(43.15±4.33) mmHg vs (47.08±5.12) mmHg]，TNF-α[(2.26±0.35) ng/mL vs (3.69±1.25) ng/mL]，IL-8[(2.31±0.65) vs (4.32±1.76) ng/mL]，hs-CRP[(7.35±2.26) mg/L vs (14.15±5.32) mg/L]低于对照组，差异有统计学意义(P<0.05)。观察组O2sat[(89.25±6.35)% vs (80.24±5.39)%]，PO2[(65.34±7.95) mmHg vs (54.23±6.07) mmHg]，pH[(7.49±0.65) vs (7.31±0.52)]高于对照组，差异有统计学意义(P<0.05)。结论：甲泼尼龙可提高SCAP疗效，并有效降低血清炎症因子水平。
关键词：
甲泼尼龙；重症社区获得性肺炎；炎症因子；肺炎；社区获得性肺炎；炎症因子
Effect of methylprednisolone on severe community-acquired pneumonia and its impact on the level of serum inflammatory factors
CorrespondingAuthor: SHEN Fangfang Email: hbxms2008@163.com
DOI: 10.3978/j.issn.2095-6959.2020.07.016
Foundation: This work was supported by Beijing Science and Technology Commission Project, China (D151100004123009).
Abstract
Objective: To investigate the therapeutic effect of methylprednisolone on severe community acquired pneumonia (SCAP) and its effect on serum inflammatory factors. Methods: Eighty patients with SCAP admitted to Beijing Chaoyang Emergency Rescue Center from February 2014 to February 2018 were randomly divided into 2 groups. The control group (40 cases) received basic treatment such as anti-infection. The observation group (40 cases) received methylprednisolone on the basis of basic treatment. All patients were treated for 1 week. The therapeutic effect, time of clinical symptom disappearance, changes of blood gas index and inflammatory factors before and after the treatment were observed. Results: The effective rate of the observation group was higher than that of the control group (90.00% vs 70.00%, P<0.05); fever [(2.01±0.19) d vs (3.14±0.25) d], wheezing [(3.26±0.39) d vs (5.24±0.69) d], lung moist rales [(3.76±0.52) d vs (5.37±0.63) d], duration of cough and expectoration [(5.13±0.92) d vs (6.35±0.25) d] in the observation group were shorter than those in the control group. The differences were statistically significant (P<0.05). After the treatment, arterial oxygen saturation (O2sat), arterial oxygen partial pressure (PO2), arterial pH increased; arterial carbon dioxide partial pressure (PCO2) and levels of serum tumor necrosis factor-α (TNF-α), interleukin-8 (IL-8), and high-sensitivity C-reactive protein (hs-CRP) decreased. The differences were statistically significant (P<0.05). After the treatment, PCO2 [(43.15±4.33) mmHg vs (47.08±5.12) mmHg] and levels of serum TNF-α [(2.26±0.35) ng/mL vs (3.69±1.25) ng/mL], IL-8 [(2.31±0.65) ng/mL vs (4.32±1.76) ng/mL] and Hs-CRP [(7.35±2.26) mg/L vs (14.15±5.32) mg/L] in the observation group were lower than those of the control group. The differences were statistically significant (P<0.05). O2sat [(89.25±6.35)% vs (80.24±5.39)%], PO2 [(65.34±7.95) mmHg vs (54.23±6.07) mmHg] and pH [(7.49±0.65) vs (7.31±0.52)] of the observation group was higher than those of the control group. The differences were statistically significant (P<0.05). Conclusion: Methylprednisolone can improve the therapeutic effect of SCAP and effectively reduce the level of serum inflammatory factors.
Keywords：
methylprednisolone; severe community acquired pneumonia; inflammatory factors; pneumonia; community acquired pneumonia; inflammatory factors