目的：探讨他汀类和大环内酯类药物对肺炎链球菌肺炎早期治疗效果预后的影响。方法回顾性分析入住我院呼吸科的210例诊断为肺炎链球菌肺炎的患者,分为他汀治疗组、大环内酯类治疗组和联合治疗组,对患者的年龄、合并症、PORT评分进行比较分析。并通过COX回归分析患者的预后情况与他汀类和大环内酯类药物的关系。结果他汀类治疗组患者较非他汀类治疗组患者具有较低的死亡风险,在入院后第7、14、20和30天的死亡风险可以分别减低24%,31%,53%以及60%(P<0．05)。大环内酯类治疗患者较非大环内酯类治疗组患者的预后并无明显优势,入院第7天死亡风险降低2%,而入院14天,20天和30天死亡率增加分别39%,29%和35%,但均未发现统计学差异( P>0．05)。联合使用大环内酯类抗生素和他汀类药物治疗后,单药治疗的预后并无明显优势,入院第7天和30天死亡风险降低9%和16%,而入院14天和20天死亡率增加分别6%和11%,但均未发现统计学差异( P>0．05)。结论他汀类药物可以减少肺炎链球菌患者的死亡率,而大环内酯类药物或联合治疗均不能改善患者的预后。%Objective To evaluate the effect of combined therapy of statin and macrolide in the early treat-ment of patients with pneumococcal pneumonia. Methods 210 patients with pneumococcal pneumonia in our hospi-tal were divided into three groups:the statin treatment group, the macrolides treatment group and the combined treat-ment group. Retrospective analysis was used to analyze age, complication and PORT scores. A multivariate-adjusted Cox proportional hazard model was used to evaluate survival situation. Results Compared with non-statin treatment, the mortality risk in the statin treatment group was decreased 24%, 31%, 53%, and 60% 7, 14, 20 and 30 days after administration (P<0. 05). No difference could be found between mortality risk in the macrolides group and the non-macrolides group. The treatment of macrolides decreased 2% mortality risk on 7 days after administration and in-creased 39%, 29% and 35% mortality risk on 14, 20 and 30 days after administration respectively. The combined therapy had the similar prognosis as the single one did, and the mortality risk decreased 9% and 16% respectively on 7 and 30 days after admission and increased 6% and 11% on 14 and 20 days after admission. Conclusion The pa-tients who are receiving statin at the time of admission for pneumococcal pneumonia have better clinical outcomes than those who are not.
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