[1]沙正凯,钱　江,张祥杰,等.抗感染联合纤维支气管镜吸痰治疗对重症肺炎患者症状缓解及炎性反应的影响[J].新乡医学院学报,2016,33(12):1091-1094.[doi:10.7683/xxyxyxb.2016.12.020]
　SHA Zheng-kai,QIAN Jiang,ZHANG Xiang-jie,et al.Effect of anti infection combined with fiexible bronchofiberscope aspiration of sputum therapy on symptoms and inflammatory response in patients with severe pulmonary infection[J].Journal of Xinxiang Medical University,2016,33(12):1091-1094.[doi:10.7683/xxyxyxb.2016.12.020]
点击复制

抗感染联合纤维支气管镜吸痰治疗对重症肺炎患者症状缓解及炎性反应的影响
分享到：

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
33
期数:
2016年12
页码:
1091-1094
栏目:
临床研究
出版日期:
2016-12-05

文章信息/Info

Title:
Effect of anti infection combined with fiexible bronchofiberscope aspiration of sputum therapy on symptoms and inflammatory response in patients with severe pulmonary infection
作者:
沙正凯1; 钱　江2; 张祥杰1; 翟成凯1; 贺航咏3
（1.新乡市第一人民医院呼吸科，河南　新乡　453000；2.郑州市第十五人民医院内一科，河南　郑州　450041；3.北京朝阳医院呼吸与危重症科，北京　100020）
Author(s):
SHA Zheng-kai1; QIAN Jiang2; ZHANG Xiang-jie1; ZHAI Cheng-kai1; HE Hang-yong3
（1.Department of Respirtatorty,the First People′s Hospital of Xinxiang，Xinxiang 453000,Henan Province,China;2.Department of First Inernal Medicine,the Fifteenth People′s Hospital of Zhengzhou,Zhengzhou 450041，Henan Province,China;3.Department of Respirtation and Critically Ill,Beijing Chaoyang Hospital,Beijing 100020,China）
关键词:
重症肺炎; 抗感染; 纤维支气管镜
Keywords:
severe pulmonary infection; anti infection; fiexible bronchofiberscope
分类号:
R563.1
DOI:
10.7683/xxyxyxb.2016.12.020
文献标志码:
A
摘要:
目的　探讨抗感染联合纤维支气管镜吸痰治疗对重症肺炎患者肺功能和炎症状态的影响及可能作用机制。方法　选取2015年1月至2016年4月在新乡市第一人民医院呼吸科住院治疗的重症肺炎患者104例，根据治疗方法分为研究组和对照组，每组52例，对照组患者进行常规抗感染治疗，研究组患者在常规抗感染治疗基础上联合纤维支气管镜吸痰。比较2组患者治疗后的肺功能指标、炎性相关因子、病情严重程度相关指标；Western blot 法检测Toll样受体2/转录因子蛋白κB（TLR2/NF-κB）和氨基末端激酶/应激活化蛋白激酶（JNK/SAPK）信号通路下游分子的蛋白表达情况。结果　研究组患者治疗后1 s用力呼气容积、最大通气量、最大呼气中期流量、功能残气量、肺总量均显著高于对照组（P<0.05）；研究组患者治疗后血清血小板激活因子、巨噬细胞炎症蛋白-1α、可溶性髓细胞触发受体-1、降钙素原水平均显著低于对照组，脂联素水平显著高于对照组（P<0.05）；研究组患者治疗后血清血管紧张素转化酶、血清一氧化氮、血管内皮素-1、人肺表面活性蛋白、人高迁移率族蛋白水平显著低于对照组，Clara细胞分泌蛋白、胆碱酯酶水平显著高于对照组（P<0.05）；研究组患者治疗后TLR2、NF-κB、 JNK、SAPK表达水平均显著低于对照组（P<0.05）。结论　抗感染联合纤维支气管镜吸痰治疗能够有效改善重症肺炎患者的症状，抑制炎症反应，其机制可能与下调TLR2/NF-κB和JNK/SAPK信号通路表达有关。
Abstract:
Objective　To investigate the effect of anti infection combined with fiexible bronchofiberscope aspiration of sputum therapy on the pulmonary function and inflammatory status in patients with severe pulmonary infection and explore the possible mechanism.Methods　One hundred and four patients with severe pneumonia in Department of Respirtatorty of the First People′s Hospital of Xinxiang from January 2015 to April 2016 were selected and divided into study group and control group,with 52 patients in each group.The patients in control group were given conventional anti infective therapy;based on this,the patients in study group were given fiexible bronchofiberscope aspiration of sputum therapy.The pulmonary function indicators,inflammation related factors and disease severity related indicators of patients after treatment were compared between the two groups.The expression of Toll-like receptors 2/nuclear factor-kappa B(TLR2/NF-κB)and c-Jun N-terminal kinase/stress-activated protein kinases(JNK/SAPK) were detected by Western blot.Results　After treatment,the levels of forced expiratory volume in one second,maximum minute ventilation,maximum midexpiratory flow,functional residual capacity and total lung capacity of patients in the study group were significantly higher than those in the control group (P<0.05).The levels of serum platelet activating factor,macrophage inflammatory protein-1α,human soluble triggering receptor expresses on myeloid cells-1 and procalcitonin of patients in the study group were significantly lower than those in the control group（P<0.05）;but adiponectin levels were significantly higher than those in the control group(P<0.05).The serum levels of angiotensin converting enzyme,nitric oxide,endothelin-1,human pulmonary surfatcant-associated protein A and human high-mobility group box-1 in the study group were significantly lower than those in the control group（P<0.05）;but the Clara cell secretory 16-kd protein and choline esterase levels were significantly higher than those in the control group（P<0.05）.The expression of TLR2,NF-κB,JNK and SAPK protein in study group were significantly lower than those in the control group(P<0.05).Conclusion　Anti infection combined with fiexible bronchofiberscope aspiration of sputum can improve the symptoms of patients with severe pneumonia and inhibit the inflammatory response,which may be related to the down-regulation of the expression of NF-κB and JNK/SAPK signaling pathway.

参考文献/References:

［1］　DIMARAKIS I,PASCHALIS A,HOSCHTITZKY J A，et al.Central pulmonary thrombosis secondary to severe infection of a right ventricle-to-pulmonary artery conduit［J］.Cardiol Young,2013,23(2):265-266.
［2］　ASTUTO M,PALERMO C I,COSTANZO C M，et al.Fatal pulmonary disease and encephalic complication in a man with HSV-1 infection:a case report ［J］.J Clin Virol,2014,59(1):59-62.
［3］　应少聪,周向东.纤维支气管镜肺泡灌洗在重症肺炎中的应用［J］.重庆医科大学学报,2010,35(11):1754-1756.
［4］　NAIR P.Nontubercular mycobacterial pulmonary infection in severe asthma［J］.Chest,2011,139(3):721-722.
［5］　陈文武.重症肺炎经纤维支气管镜支气管肺泡灌洗治疗临床观察［J］.临床肺科杂志,2013,18(6):1048-1050.
［6］　宋丽君，李春艳.肺炎支原体感染免疫学的相关问题［J］.中华实用儿科临床杂志，2016，31（9）：645-649.
［7］　KOVARI H,EBNOTHER C,SCHWEIGER A，et al.Pulmonary toxoplasmosis,a rare but severe manifestation of a common opportunistic infection in late HIV presenters:report of two cases［J］.Infection,2010,38(2):141-144.
［8］　史进,郑喜胜,齐平建,等.血必净联合支气管肺泡灌洗治疗重型颅脑损伤肺炎患者的效果分析［J］.中华医院感染学杂志,2014,24(14):3564-3566.
［9］　SHARMA J,LI Q,MISHRA B B，et al.Lethal pulmonary infection with Francisella novicida is associated with severe sepsis［J］.J Leukocyte Biol,2009,86(3):491-504.
［10］　高阳，刘冬云，孔祥斌，等.环氧合酶2抑制剂对高氧环境下新生大鼠肺组织肺表面活性物质相关蛋白B、转化生长因子-β1表达的影响［J］.中华实用儿科临床杂志，2016，31（14）：1081-1085.
［11］　SLIGHT-WEBB S R,BAGAVANT H,CROWE S R，et al.Influenza A(H1N1) virus infection triggers severe pulmonary inflammation in lupus-prone mice following viral clearance［J］.J Autoimmun,2015,57:66-76.

相似文献/References:

[1]郜素云,薛训杰,齐文清,等.肝素佐治重症肺炎(附20例报告)[J].新乡医学院学报,1993,10(04):287.
[2]王红梅,黄丽蓉.重症肺炎患者细胞免疫功能研究[J].新乡医学院学报,2011,28(06):000.
[3]臧　宁,潘海祥,李荣新,等.降钙素原和 Ｃ反应蛋白联合检测在重症肺炎患儿病情和预后评估中的价值[J].新乡医学院学报,2015,32(09):849.
[4]吴述光,侯小丽,马胜喜.重症肺炎并发脓毒症患者血清高迁移率族蛋白B1检测的临床意义[J].新乡医学院学报,2018,35(2):143.[doi:10.7683/xxyxyxb.2018.02.016]
　WU Shu-guang,HOU Xiao-li,MA Sheng-xi.Clinical significance of high mobility group protein B1 in patients with severe pneumonia complicated with sepsis[J].Journal of Xinxiang Medical University,2018,35(12):143.[doi:10.7683/xxyxyxb.2018.02.016]
[5]殷　波,赵寅滢.亚胺培南西司他丁钠治疗重症肺炎疗效观察[J].新乡医学院学报,2017,34(12):1128.[doi:10.7683/xxyxyxb.2017.12.022]
　YIN Bo,ZHAO Yin-ying.Effect of imipenem and cilastatin sodium in the treatment of severe pneumonia[J].Journal of Xinxiang Medical University,2017,34(12):1128.[doi:10.7683/xxyxyxb.2017.12.022]
[6]刘雪娇,谭晓纯,何　宁.老年重症肺炎患者病原菌分布及支气管镜肺泡灌洗术的治疗效果与安全性[J].新乡医学院学报,2022,39(9):838.[doi:10.7683/xxyxyxb.2022.09.008]
　LIU Xuejiao,TAN Xiaochun,HE Ning.Distribution of pathogenic bacteria in elderly patients with severe pneumonia and the therapeutic effect and safety of bronchoscopy alveolar lavage[J].Journal of Xinxiang Medical University,2022,39(12):838.[doi:10.7683/xxyxyxb.2022.09.008]
[7]曲春雨,卢灵灵,王素魏,等.血清白细胞介素-10和中性粒细胞明胶酶相关脂质运载蛋白水平对纤维支气管镜吸痰灌洗治疗重症肺炎患者预后的预测价值[J].新乡医学院学报,2022,39(10):978.[doi:10.7683/xxyxyxb.2022.10.015]
　QU Chunyu,LU Lingling,WANG Suwei,et al.Predictive value of serum interleukin-10 and neutrophil gelatinase associated lipocalin levels on the prognosis of patients with severe pneumonia treated with sputum aspiration and lavage by fiberoptic bronchoscopy[J].Journal of Xinxiang Medical University,2022,39(12):978.[doi:10.7683/xxyxyxb.2022.10.015]
[8]马群,李卫阳,许蒙.老年重症肺炎并呼吸衰竭患者血清可溶性CD40配体和正五聚体蛋白-3水平变化及临床意义[J].新乡医学院学报,2023,40(7):659.[doi:10.7683/xxyxyxb.2023.07.011]
　MA Qun,LI Weiyang,XU Meng.Changes and clinical significance of serum soluble CD40 ligand and pentraxin-3 levels in elderly patients with severe pneumonia and respiratory failure[J].Journal of Xinxiang Medical University,2023,40(12):659.[doi:10.7683/xxyxyxb.2023.07.011]
[9]苗芝育,张磊,李晓燕,等.乳酸/白蛋白比值、白细胞介素-6、CD4T淋巴细胞计数对重症肺炎并脓毒症患者短期预后的预测价值[J].新乡医学院学报,2024,(3):232.[doi:10.7683/xxyxyxb.2024.03.007]
　MIAO Zhiyu,ZHANG Lei,LI Xiaoyan,et al.Predictive value of lactate/albumin ratio,interleukin-6 and CD4 T lymphocyte count in the short-term prognosis of severe pneumonia and sepsis[J].Journal of Xinxiang Medical University,2024,(12):232.[doi:10.7683/xxyxyxb.2024.03.007]

更新日期/Last Update: 2016-12-05