利奈唑胺治疗肺结核合并重症肺炎的疗效及对患者免疫因子和预后的影响

目的探究利奈唑胺治疗肺结核合并重症肺炎的疗效及其对免疫因子和预后的影响。方法选取2016年1月—2017年1月于杭州市红十字会医院就诊的98例肺结核合并重症肺炎患者,按随机数字表法分为对照组(49例)和观察组(49例),在抗结核治疗基础上,分别给予亚胺培南西司他丁和亚胺培南西司他丁联合利奈唑胺治疗,随访28 d,比较2组患者临床疗效、细菌清除率、治疗前后免疫功能、细胞因子水平、生存情况及不良反应发生率。结果观察组治疗总有效率高于对照组(89. 80%vs. 73. 47%,P=0. 037);观察组的细菌清除率高于对照组(79. 59%vs. 57. 14%,P=0. 017); 2组患者CD4^+、CD8^+、CD4^+/CD8^+、Ig A及Ig G水平高于治疗前(均P <0. 05),观察组上述指标高于对照组(均P <0. 05); 2组患者IL-6、IL-8和TNF-α水平低于治疗前(均P <0. 05),观察组上述指标低于对照组(均P <0. 001);观察组患者的生存率高于对照组(HR=0. 360,95%CI:0. 153～0. 849,P=0. 027); 2组患者治疗后不良反应发生率差异无统计学意义(12. 24%vs. 10. 20%,P=0. 749)。结论利奈唑胺治疗肺结核合并重症肺炎,可以提高临床疗效,增强免疫功能,降低细胞因子并提高生存率,且安全性有保证。

Clinical efficacy of linezolid in the treatment of pulmonary tuberculosis complicated with severe pneumonia and effects on immune factors and prognosis

Objective To explore the clinical efficacy of linezolid in the treatment of pulmonary tuberculosis complicated with severe pneumonia and effects on immune factors and prognosis. Methods From January 2016 to January 2017, 98 patients with pulmonary tuberculosis complicated with severe pneumonia were randomly divided into the control group (49cases) and the observation group (49 cases). On the basis of anti-tuberculosis treatment, the two groups were treated with imipenem cilastatin and imipenem cilastatin combined with linezolid, respectively, both groups were followed up for28 days. The clinical efficacy, bacterial clearance rate, immune function, cytokine levels, prognosis and incidence of adverse reactions were compared between the two groups after treatment. Results The total effective rate of the observation group was significantly higher than that of the control group (89.80% vs. 73.47%, P=0.037), and the bacterial clearance rate of the observation group was significantly higher than that of the control group (79.59% vs. 57.14%, P=0.017). The levels of CD4+, CD8+, CD4+/CD8+, Ig A and Ig G in the two groups were significantly higher than those before the treatment (all P < 0.05), and the above indexes in the observation group were higher than those in the control group (all P < 0.05). The levels of IL-6, IL-8 and TNF-α in the two groups were significantly lower than those before the treatment (P < 0.05), and the above indexes in the observation group were significantly lower than those in the control group (all P < 0.001). The survival rate of the observation group was significantly higher than that of the control group (HR=0.360, 95% CI:0.153-0.849, P=0.027); There was no significant difference in the incidence of adverse reactions after treatment between the two groups (12.24% vs. 10.20%, P=0.749). Conclusion Linazolamide can improve clinical efficacy, enhance immune function, reduce serum cytokine levels and improve the survival rate of patients in the treatment of pulmonary tuberculosis with severe pneumonia, and the safety is guaranteed.