益气健脾法治疗卒中后肺部多重耐药菌感染的真实世界研究

[目的] 观察益气健脾法方药治疗卒中后肺部多重耐药菌(MDRB)感染的临床疗效。[方法] 基于真实世界研究方法,回顾性收集2018年1月至2021年5月期间首次诊断为卒中后肺部MDRB感染病例,共113例。根据是否采用益气健脾法方药分为暴露组(40例)和非暴露组(73例),通过倾向性评分匹配(PSM)产生最佳配对,比较两组患者肺炎改善情况和感染指标变化;采用Kaplan-Meier方法和Cox回归分析评估患者生存情况。[结果] 经过PSM,两组各纳入36例患者,且各项指标均达到良好匹配。短期内暴露组疗效优于非暴露组,差异有统计学意义(P<0.05);治疗后暴露组外周血白细胞计数、降钙素原水平均显著低于非暴露组,差异有统计学意义(P<0.05)。长期预后分析显示暴露组1年内生存率(77.8%)高于非暴露组(47.2%,Log-rank P=0.009),且益气健脾法方药的使用是卒中后肺部MDRB感染预后的保护性因素(HR=0.423)。[结论] 真实世界中,益气健脾法方药可以改善卒中后肺部MDRB感染短期疗效及长期生存情况。

A real-world study on the treatment of pulmonary multidrug-resistant bacteria infection after stroke by the benefiting vital qi and strengthening spleen therapy

[Objective] To observe the clinical efficacy of the formula using benefiting vital Qi and strengthening spleen therapy in treating patients with pulmonary multidrug-resistant bacteria(MDRB) infection after stroke.[Methods] Based on real-world study methods, 113 cases with first diagnosis of pulmonary MDRB infection after stroke between January 2018 and May 2021 were collected retrospectively. They were divided into exposed group(40 cases) and non-exposed group(73 cases) according to whether or not they used the benefiting vital qi and strengthening spleen therapy. The best pairs were generated by propensity score match(PSM) to compare improvements of pneumonia and changes in infection indicators between the two groups,Kaplan-Meier method and Cox regression were used for survival analysis.[Results] After PSM,36 patients were included in each of the two groups,and all indicators were well matched. In the short term,the efficacy of the exposed group was better than that of the non-exposed group,with a statistically significant difference (P<0.05),and the peripheral blood leukocyte count and procalcitonin were significantly lower in the exposed group than in the non-exposed group after treatment,with a statistically significant difference(P<0.05). Long-term prognostic analysis showed that the survival rate within 1 year was higher in the exposed group(77.8%) than in the non-exposed group(47.2%),Log-rank P=0.009,and the use of the formula for benefiting vital Qi and strengthening spleen therapy was a protective factor for the prognosis of pulmonary MDRB infection after stroke(HR=0.423).[Conclusion] The formula using benefiting vital qi and strengthening spleen therapy can improve the short-term outcome and long-term survival of pulmonary MDRB infection after stroke in the real world.