麻杏饮加减联合替加环素治疗广泛耐药鲍曼不动杆菌致呼吸机相关性肺炎的疗效及对T淋巴细胞亚群的影响

Efficacy of modified Maxingyin decoction combined with tigecycline in the treatment of XDRAB ventilator-associated pneumonia and its effect on T lymphocyte subsets

摘要:

目的 观察麻杏饮加减联合替加环素治疗广泛耐药鲍曼不动杆菌（XDRAB）致呼吸机相关性肺炎（VAP）的疗效及对T淋巴细胞亚群的影响。方法 选取2019年2月—2021年6月河北省中医院收治的128例XDRAB致VAP患者，按随机数字表法分为对照组和研究组，每组64例。对照组给予替加环素治疗；研究组给予麻杏饮加减联合替加环素治疗。比较两组患者持续治疗2周后的疗效；比较两组患者中医症状积分、临床疗效、微生物学疗效；比较两组血清炎症因子、T淋巴细胞亚群变化情况；统计两组患者不良反应情况。结果 研究组治疗前后主症、次症中医证候评分差值大于对照组（P <0.05）。研究组总有效率、细菌清除率高于对照组（P <0.05）。研究组治疗前后C-反应蛋白（CRP）、白细胞介素-4（IL-4）、降钙素原（PCT）、白细胞计数、中性粒细胞CD11b差值大于对照组（P <0.05）。研究组治疗前后Th1/Th2、Th17/Treg差值大于对照组（P <0.05）。两组患者总不良反应发生率比较，差异无统计学意义（P >0.05）。结论 麻杏饮加减联合替加环素治疗XDRAB所致VAP可增强治疗效果，抑制炎症因子表达，增强免疫功能，且安全性良好。

Abstract:

Objective To observe the efficacy of modified Maxingyin decoction combined with tigecycline in the treatment of extensively drug-resistant Acinetobacter baumannii (XDRAB) ventilator-associated pneumonia (VAP) and its effect on T lymphocyte subsets.Methods 128 VAP patients with XDRAB admitted to our hospital，they were divided into control and study groups by random number table method from February 2019 to June 2021, with 64 cases in each group. The control group was given tigecycline, and the study group was given Maxing Decoction combined with tigecycline. Both groups were treated for 2 weeks and the effect was observed. The TCM symptom scores, clinical efficacy and microbiological efficacy of the two groups were recorded. The changes of serum inflammatory factors and T lymphocyte subsets in the two groups were compared. The drug safety of the two groups was recorded.Results The difference of TCM syndrome scores of main symptom and secondary symptom in the study group before and after treatment were higher than those in the control group (P < 0.05). The total effective rate and bacterial clearance rate of the study group were higher than those of the control group (P < 0.05). The difference of C-reactive protein (CRP), procalcitonin (PCT), interleukin-4 (IL-4), white blood cell count and neutrophil CD11b in the study group before and after treatment were higher than those in the control group (P < 0.05). Th1/Th2 and Th17/Treg in the study group before and after treatment were higher than those in the control group (P < 0.05). There was no significant difference in the incidence of total adverse reactions between the two groups (P > 0.05).Conclusion Modified Maxingyin decoction combined with tigecycline in the treatment of XDRABVAP can enhance the therapeutic effect, inhibit the expression of inflammatory factors, and enhance immune function, with good safety.