达托霉素对MRSA致脓毒血症患者血清和肽素与降钙素原水平的影响

摘要

Objective To investigate the effect of daptomycin on the serum levels of proclacitonin (PCT) and copeptin in septicopyemia patients induced by methicillin-resistant Staphylococcus aureus (MRSA). Methods 54 cases septicopyemia patients induced by MRSA were selected and divided into two groups, 27 cases in each group. The two groups received fluid replacement therapy and nutrition support, the control group received vancomycin (0.5g per times, three times daily) with intravenous drip, and the study group received daptomycin (6mg/kg, once daily) with intravenous drip. The serum PCT, proclacitonin levels pre-and post-treatment in two groups were detected, the acute physiology and chronic health evaluationⅡ (APACHEⅡ) and sepsis-related organ failure assessment (SOFA) were used to evaluate the patients' condition, the clearance time of pathogenic bacteria was recorded and the clinical efficacy was compared between two groups. Results Compared with before treatment, serum PCT, C-reactive protein (CRP), interleukin-1β(IL-1β) and IL-6 in two groups decreased(P<0.01), the count of WBC, NE% and copeptin decreased (P<0.01), the APACHEⅡ and SOFA score were lower(P<0.05); compared with the control group, the PCT, CRP, IL-1 beta and IL-6 in study group were lower(P<0.05), the count of WBC, NE% and copeptin level were lower(P<0.05), APACHEⅡ and SOFA score were lower(P<0.05), the pathogen clearance rate was higher(P<0.05), clearance time was shorter(P<0.05), the total efficiency was higher(P<0.05). Conclusion Daptomycin can reduce serum PCT and copeptin in patients with septicopyemia induced by MRSA, and remove pathogenic bacteria rapidly, inhibit the inflammatory reaction, safe and reliable.%目的 探讨达托霉素对耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus,MRSA)所致脓毒血症患者血清和肽素及降钙素原(proclacitonin,PCT)水平的影响.方法 研究对象选取54例MRSA所致脓毒血症,随机分成2组,每组27例.2组均予补液、营养支持等对症治疗,对照组予万古霉素(0.5g/次,3次/天)静点,研究组予达托霉素(6mg/kg,1次/天)静点.检测治疗前后血清PCT、和肽素等指标水平,行急性生理学及慢性健康状况评分(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分及序贯器官衰竭估计评分(sepsis-related organ failure assessment,SOFA)评估,密切观察记录病原菌清除时间,比较临床疗效.结果 与治疗前比较,2组血清PCT、C反应蛋白(C-reactive protein,CRP)、白介素-1β(interleukin-1β,IL-1β)及白介素-6(IL-6)水平降低(P<0.05),白细胞计数(WBC)、中性粒细胞百分比(NE%)及和肽素水平降低(P<0.05),APACHEⅡ和SOFA评分降低(P<0.05);与对照组比较,研究组PCT、CRP、IL-1β及IL-6水平较低(P<0.05),WBC计数、NE%及和肽素水平较低(P<0.05),APACHEⅡ评分及SOFA评分较低(P<0.05),病原菌清除率较高(P<0.05),清除时间较短(P<0.05),总有效率较高(P<0.05).结论 达托霉素能降低MRSA所致脓毒血症患者血清和肽素及PCT水平,快速清除病原菌,抑制炎症反应,安全可靠.