涂思义+张川林+王春娥

[摘要]目的 观察痰热清对铜绿假单胞菌肺部感染细胞因子的影响。方法 选取2013年4月～2014年8月我院收治的128例铜绿假单胞菌肺部感染患者作为研究对象，按照不同的治疗方法分为对照组（64例）和观察组（64例），两组均根据药敏结果进行常规抗感染治疗，观察组加用痰热清注射液治疗。比较两组患者临床疗效、治疗前后血清细胞因子IL-6、IL-8和IL-10的水平变化及治疗后细菌清除率。结果 观察组治疗总有效率为95.31%，显著高于对照组的81.25%，差异有统计学意义（P<0.05）；两组治疗前后IL-6、IL-8、IL-10水平均显著变化，且观察组治疗后IL-6、IL-8水平低于对照组，IL-10水平高于对照组，差异有统计学意义（P<0.05）；观察组患者痰液中铜绿假单胞菌清除率显著高于对照组，差异有统计学意义（P<0.05）。结论 在常规抗炎、抗感染治疗的基础上加用痰热清能明显提高治疗效果，有效调节细胞因子水平，值得在临床上推广。

[关键词]铜绿假单胞菌；肺部感染；细胞因子；痰热清注射液

[中图分类号] R563 [文献标识码] A [文章编号] 1674-4721（2017）01（c）-0042-03

[Abstract]Objective To observe the effect of Tanreqing Injection on cytokines in patients with Pseudomonas aeruginosa pulmonary infection.Methods 128 cases of pulmonary infection patients with Pseudomonas aeruginosa in our hospital from April 2013 to August 2014 were selected as research objects and divided into observation group （n=64） and control group （n=64） according to different treatment methods，patients in two groups were treated with conventional anti infection therapy according to the results of drug sensitivity，patients in the observation group were added with Tanreqing Injection.Clinical efficacy of two groups，serum cytokine levels of IL-6，IL-8 and IL-10 before and after treatment，and bacterial clearance rate after treatment were compared.Results Total effective rate in the observation group was 95.31%，which was significantly higher than 81.25% in the control group，the difference was statistically significant （P<0.05）；the levels of IL-10，IL-8 and IL-6 in two groups were significantly changed before and after treatment，and the levels of IL-8，IL-6 in the observation group was lower than that in the control group，the IL-10 level was higher than that in the control group，the difference was statistically significant （P<0.05）；Pseudomonas aeruginosa clearance rate in the sputum of the observation group was significantly higher than that in the control group，the difference was statistically significant （P<0.05）.Conclusion The treatment of Tanreqing on the base of conventional anti-inflammatory and anti infective therapy can significantly improve therapeutic effect，and regulate cytokine levels.It is worth to be popularized in clinical application.

[Key words]Pseudomonas aeruginosa；Pulmonary infection；Cytokine；Tanreqing Injection

肺部感染多是指由于病原微生物感染導致的，包括终末气道、肺泡腔及肺间质在内的肺实质炎症，院内肺部感染常发生于免疫功能差的患者，表现为发病急、病情重以及病情变化迅速[1]。肺部感染常见的革兰阴性致病菌为铜绿假单胞，近年来，由于铜绿假单胞的多重耐药株逐渐增多，使得铜绿假单胞菌肺部感染的患病率和病死率也不断增加。铜绿假单胞菌感染后，局部免疫细胞被激活，并产生IL-6、IL-8以及IL-10等炎性细胞因子。其中IL-6、IL-8水平增加会加速炎症的发展，而IL-10水平的增加则具有相反的作用，因此血清中各细胞因子水平是衡量炎症发展的重要指标。临床上治疗铜绿假单胞菌引起的肺部感染时，在根据药敏实验抗感染治疗的基础上联合使用痰热清注射液，通过监测血清中IL-6、IL-8和IL-10的水平，分析该药对患者血清细胞因子水平的影响，现报道如下。……