穿心莲内酯总酯磺化物对肺部感染患者血清炎性标志物的影响及其临床疗效观察

摘要

目的 探讨穿心莲内酯总酯磺化物对肺部感染患者血清炎性标志物的影响及临床疗效.方法 选择2013年9月至2015年1月于兰州军区兰州总医院呼吸内科就诊的肺部感染患者100例,按随机化原则分为观察组和对照组,各50例.对照组给予盐酸氨溴索注射液30 mg静脉滴注,1次/d,并给予对症治疗.观察组在对照组治疗的基础上给予穿心莲内酯总酯磺化物250 mg静脉滴注,1次/d.2组均治疗10 d.比较2组治疗前,治疗3、7、10 d后白细胞介素6(IL-6)、降钙素原、白细胞计数、中性粒细胞百分比以及治疗l0d后咳嗽、咳痰、发热、呼吸困难症状改善情况和肺部感染吸收情况.结果 治疗前,2组IL-6、降钙素原、白细胞计数、中性粒细胞百分比差异均无统计学意义(均P＞0.05).观察组治疗3、7、10 d后IL-6、降钙素原和治疗7d后白细胞计数及中性粒细胞百分比均明显低于对照组[IL-6:(26±5) ng/L比(28±4)ng/L,(20±7)ng/L比(22±4) ng/L,(12±5)ng/L比(14±5) ng/L;降钙素原:(2.09±0.48) μg/L比(3.28±0.46)μg/L,(1.39±0.42) μg/L比(2.92±0.38) μg/L,(0.60±0.12) μg/L比(2.01±0.29) μg/L;白细胞计数:(6.8±1.8)×109/L比(8.1±2.2)×109/L;中性粒细胞百分比:(65.5±1.8)％比(68.2±7.7)％],差异均有统计学意义(均P＜0.05).治疗前,2组咳嗽、咳痰、发热、呼吸困难症状积分及X线异常比例比较,差异均无统计学意义(均P＞ 0.05).治疗10 d后,2组咳嗽、咳痰、发热、呼吸困难症状积分均明显高于治疗前[观察组:(2.48±0.52)分比(1.01±0.59)分、(2.67±0.01)分比(1.14±0.96)分、(2.77±0.20)分比(1.02±0.16)分、(2.38±0.12)分比(1.57±0.14)分;对照组:(2.02±0.55)分比(1.27土1.05)分、(2.00±0.48)分比(1.25±0.28)分、(2.04±0.31)分比(1.04±0.17)分、(2.04 0.24)分比(1.48±0.13)分],且观察组明显高于对照组;X线异常患者比例明显低于治疗前[观察组:24.0％ (12/50)比86.0％(43/50);对照组:60.0％ (30/50)比82.0％ (41/50)],且观察组明显低于对照组,差异均有统计学意义(均P ＜0.05).结论 穿心莲内酯总酯磺化物可明显降低肺部感染患者血清中炎性标志物水平,改善患者临床症状,促进肺部感染吸收.%Objective To explore the effect of andrographolidume on serum inflammatory markers in patients with lung infection and observe the clinical curative effect.Methods Totally 100 patients with lung infection from September 2013 to January 2015 were enrolled and randomly divided into observation group and control group (50 cases in each).Based on symptomatic treatment,both groups were intravenously dripped with ambroxol hydrochloride injection (30 mg,1 time/d),observation group was additionally given intravenous drip of andrographolide sulfonate ester (250 mg,1 time/d).The treatment lasted for 10 d.The interleukin-6 (IL-6),procalcitonin (PCT),white blood cell count (WBC),neutrophilic granulocyte percentage were compared between groups before and 3,7,10 d after treatment;the improvement of cough,sputum,fever,dyspnea and pulmonary infection absorption were also compared between groups before and 10 d after treatment.Results Before treatment,the IL-6,PCT,WBC and neutrophilic granulocyte percentage were not significantly different between groups (P ＞0.05).The IL-6 and PCT 3,7,10 d after treatment,the WBC and neutrophilic granulocyte percentage 7 d after treatment were significantly lower than in observation group than those in control group,in observation group were significantly lower than that in control group[IL-6:(26 ±5) ng/L vs (28 ±4) ng/L,(20 ±7) ng/L vs (22 ±4) ng/L,(12±5) ng/Lvs (14±5) ng/L;PCT:(2.09±0.48) μg/L vs (3.28±0.46) μg/L,(1.39±0.42) μg/L vs (2.92 ±0.38) μg/L,(0.60 ±0.12) μg/L vs (2.01 ±0.29) μg/L;WBC:(6.8 ± 1.8) ×109/L vs (8.1 ±2.2) × 109/L;neutrophilic granulocyte percentage:(65.5 ± 1.8)％ vs (68.2 ±7.7)％] (P ＜0.05).Before treatment,the symptom integrals of cough,sputum,fever,and dyspnea and proportion of abnormality in X-ray were not significantly different between groups;10 d after treatment,the symptom integrals of cough,sputum,fever,and dyspnea were significantly increased,the proportion of abnormality in X-ray was significantly reduced compared with pretreatment in both groups [observation group:(2.48 ±0.52) scores vs (1.01 ±0.59) scores,(2.67 ±0.01) scores vs (1.14 ±0.96) scores,(2.77 ±0.20) scores vs (1.02 ±0.16) scores,(2.38 ± 0.12) scores vs (1.57±0.14) scores,24.0％ (12/50) vs 86.0％ (43/50);control group:(2.02 ±0.55) scores vs (1.27 ± 1.05) scores,(2.00 ± 0.48) scores vs (1.25 ± 0.28) scores,(2.04 ± 0.31) scores vs (1.04±0.17) scores,(2.04 ±0.24) scores vs (1.48 ±0.13) scores,60.0％ (30/50) vs 82.0％ (41/50)],and they were all significantly different between groups (P ＜ 0.05).Conclusion Andrographolidume can significantly decrease the levels of inflammatory markers,improve the clinical symptoms and promote the lung infection absorption in patients with pulmonary infection.