| 46 | 0 | 98 |
| 下载次数 | 被引频次 | 阅读次数 |
目的观察小剂量甲泼尼龙辅助阿米卡星/头孢他啶治疗铜绿假单胞菌所致重症社区获得性肺炎（CAP）的效果及安全性。方法选取铜绿假单胞菌所致重症CAP患者83例，采用随机数字表法分为对照组41例和研究组42例。对照组给予阿米卡星联合头孢他啶及对症支持治疗，研究组在对照组基础上加用小剂量甲泼尼龙。比较两组治疗前后血清炎症指标C反应蛋白（CRP）、肿瘤坏死因子α（TNF-α）、白细胞介素4（IL-4）、IL-6，外周血细胞相关炎症指标中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、淋巴细胞与单核细胞比值（LMR）、系统免疫炎症指数（SII），并比较两组临床疗效及不良事件发生情况。结果治疗前，两组CRP、TNF-α、IL-4、IL-6、NLR、PLR、LMR及SII比较差异均无统计学意义（P均>0.05）。治疗后，两组CRP、TNF-α、IL-6、NLR、PLR及SII均较治疗前降低，IL-4及LMR均较治疗前升高；且研究组TNF-α、IL-6、NLR及SII均低于对照组（P均<0.05），两组CRP、IL-4、PLR及LMR比较差异均无统计学意义（P均>0.05）。对照组和研究组治疗总有效率分别为73.17%和80.95%，不良事件总发生率分别为7.32%和11.90%，两组治疗总有效率及不良事件总发生率比较差异均无统计学意义（P均>0.05）。结论在阿米卡星联合头孢他啶治疗基础上加用小剂量甲泼尼龙，可能进一步降低铜绿假单胞菌所致重症CAP患者TNF-α、IL-6、NLR及SII水平，但尚未显示出明确的临床疗效和安全性优势。
Abstract：Objective To observe the efficacy and safety of low-dose methylprednisolone as an adjunct to amikacin/ceftazidime in the treatment of severe community-acquired pneumonia (CAP) caused by Pseudomonas aeruginosa. Methods A total of 83 patients with severe CAP caused by P. aeruginosa were enrolled and randomly assigned via a random number table to a control group (41 cases) or a study group (42 cases). The control group received amikacin plus ceftazidime combined with symptomatic and supportive care， while the study group received additional low-dose methylprednisolone on top of the same regimen. Serum inflammatory markers， including C-reactive protein (CRP)， tumor necrosis factor-α (TNF-α)， interleukin-4 (IL-4)， and IL-6， as well as peripheral blood cell-derived inflammatory parameters， including neutrophil-to-lymphocyte ratio (NLR)， platelet-to-lymphocyte ratio (PLR)， lymphocyte-to-monocyte ratio (LMR)， and systemic immune-inflammation index (SII)， were compared between the two groups before and after treatment. Clinical efficacy and adverse events were also compared between groups. Results Before treatment， there were no statistically significant differences in CRP， TNF-α， IL-4， IL-6， NLR， PLR， LMR， or SII between the two groups (all P > 0.05). After treatment， CRP， TNF-α， IL-6， NLR， PLR， and SII decreased significantly in both groups， whereas IL-4 and LMR increased significantly compared with baseline. The study group showed significantly lower levels of TNF-α， IL-6， NLR， and SII than the control group (all P < 0.05)， while no significant differences were observed in CRP， IL-4， PLR， or LMR between the two groups (all P > 0.05). The overall response rates were 73.17% in the control group and 80.95% in the study group， and the total incidence of adverse events was 7.32% and 11.90%， respectively， with no statistically significant differences between the two groups in either measure (both P > 0.05). Conclusion The addition of low-dose methylprednisolone to amikacin plus ceftazidime may further reduce TNF-α， IL-6， NLR， and SII levels in patients with severe CAP caused by P. aeruginosa， but it has not yet demonstrated a clear advantage in clinical efficacy or safety.
[1] 周星缘，洪航，方挺，等.肺炎流行病学研究进展[J].预防医学，2023，35(8):682-686.
[2] 张颜苹，霍建民，陈晓灿.成人社区获得性肺炎病情评估的研究进展[J].临床肺科杂志，2020，25(1):143-146.
[3] 李欣昱，武轶群，林连君.社区获得性肺炎远期死亡风险的研究进展[J].国际老年医学杂志，2023，44(1):99-101.
[4] 杨志春，朱鸿丹，赵云静，等.β-内酰胺类药物联合大环内酯类药物治疗成人社区获得性肺炎的研究进展[J].实用临床医药杂志，2022，26(5):139-143.
[5] 杨慧园，况凤燕.喜炎平注射液联合哌拉西林钠舒巴坦与阿米卡星治疗社区获得性肺炎的疗效[J].临床合理用药，2023，16(15):64-67.
[6] 玄春实.糖皮质激素治疗老年重症社区获得性肺炎的效果及对患者血清炎症因子水平的影响[J].中国实用医药，2021，16(27):104-106.
[7] 郎元法，张玉余，张玮，等.糖皮质激素联合阿奇霉素对难治性支原体肺炎患儿的疗效及影响因素分析[J].河北医药，2023，45(14):2106-2110.
[8] 隋洪飞，马艳.糖皮质激素治疗儿童肺炎支原体肺炎的临床应用现状[J].天津药学，2021，33(2):60-64.
[9] 中华医学会，中华医学会杂志社，中华医学会全科医学分会，等.成人社区获得性肺炎基层诊疗指南(2018年)[J].中华全科医师杂志，2019，18(2):117-126.
[10] 中华医学会呼吸病学分会感染学组.中国铜绿假单胞菌下呼吸道感染诊治专家共识(2022年版)[J].中华结核和呼吸杂志，2022，45(8):739-752.
[11] 张康，谢凯，张晨曦，等.清肺解毒化痰方辅助治疗重症社区获得性肺炎痰热壅肺证的临床疗效评价[J].中华中医药杂志，2023，38(8):3969-3975.
[12] MARTIN-LOECHES I， TORRES A. New guidelines for severe community-acquired pneumonia[J]. Curr Opin Pulm Med， 2021，27(3):210-215.
[13] MARTIN-LOECHES I， GARDUNO A， POVOA P， et al. Choosing antibiotic therapy for severe community-acquired pneumonia[J]. Curr Opin Infect Dis， 2022，35(2):133-139.
[14] GRECO KINNEY A， KOVACIC SCHERRER N， SARKAR S， et al. β-lactams plus doxycycline versus azithromycin for treatment of severe community-acquired pneumonia in critically ill patients[J]. J Antimicrob Chemother， 2023，78(12):2816-2823.
[15] ?ELIKHISAR H， DA?DEMIR ILKHAN G， ARABACI ?. Prognostic factors in elderly patients admitted to the intensive care unit with community-acquired pneumonia[J]. Aging Male， 2020，23(5):1425-1431.
[16] RAMíREZ P， FERRER M， MARTí V， et al. Inflammatory biomarkers and prediction for intensive care unit admission in severe community-acquired pneumonia[J]. Crit Care Med， 2011，39(10):2211-2217.
[17] JIANG S， LIU T， HU Y， et al. Efficacy and safety of glucocorticoids in the treatment of severe community-acquired pneumonia: a meta-analysis[J]. Medicine (Baltimore)， 2019，98(26):e16239.
[18] BRANDS X， HAAK B W， KLARENBEEK A M， et al. Concurrent immune suppression and hyperinflammation in patients with community-acquired pneumonia[J]. Front Immunol， 2020，11:796.
[19] CHENG Z， ZHU Q， CHEN J， et al. Analysis of clinical characteristics and prognostic factors of ARDS caused by community-acquired pneumonia in people with different immune status[J]. Expert Rev Anti Infect Ther， 2022，20(12):1643-1650.
[20] CECCATO A， CILLONIZ C， RANZANI O T， et al. Treatment with macrolides and glucocorticosteroids in severe community-acquired pneumonia: a post-hoc exploratory analysis of a randomized controlled trial[J]. PLoS One， 2017，12(6):e0178022.
基本信息:
中图分类号:R563.1
引用信息:
[1]董雪姣,吴曼,郭俊玲,等.小剂量糖皮质激素辅助阿米卡星/头孢他啶治疗重症铜绿假单胞菌感染社区获得性肺炎的疗效观察[J].山东医药().
基金信息:
河北省医学科学研究课题计划项目（20220328）
2026-08-05
2026-08-05
2026-08-05