• 胸腺肽α1联合利奈唑胺提高耐甲氧西林金黄色葡萄球菌呼吸机相关性肺炎患者治疗效果和免疫功能
  • 代兆华.胸腺肽α1联合利奈唑胺提高耐甲氧西林金黄色葡萄球菌呼吸机相关性肺炎患者治疗效果和免疫功能[J].内科急危重症杂志,2021,27(6):480-483
    DOI:10.11768/nkjwzzzz20210609
    中文关键词:  胸腺肽α1  利奈唑胺  耐甲氧西林金黄色葡萄球菌  呼吸机相关性肺炎  免疫功能  Notch 信号通路
    英文关键词:
    基金项目:
    作者单位E-mail
    代兆华 邢台医学高等专科学校第二附属医院 406058936@qq.com 
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    中文摘要:
          摘要 目的:研究胸腺肽α1联合利奈唑胺对耐甲氧西林金黄色葡萄球菌(MRSA)呼吸机相关性肺炎(VAP)患者免疫功能及对外周血单个核细胞(PBMC)中Notch信号通路的影响。方法:选取邢台医学高等专科学校第二附属医院2017年6月 2020年3月收治的124例MRSA VAP患者,按照随机数字表法分为观察组和对照组,各62例。其中对照组采用常规抗感染、支持治疗及静脉滴注利奈唑胺,观察组在对照组基础上加用胸腺肽α1治疗。比较2组患者临床疗效、临床指标、治疗前/后呼吸力学指标及免疫细胞水平,检测PBMC中Notch信号通路中相关mRNA表达情况。结果:观察组总有效率高于对照组(95.16% vs 83.87%,P<0.05)。观察组的吸痰次数明显少于对照组,机械通气时间及住院时间明显短于对照组(P均<0.05)。治疗后观察组Treg明显高于对照组,Th17明显低于对照组(P均<0.05)。治疗后2组患者的呼吸力学指标(气道阻力、气道峰压、呼吸做功)及Notch信号通路中相关mRNA(Notch1、Hey1、Hes1)表达水平明显降低,且观察组明显低于对照组(P均<0.05)。结论:胸腺肽α1联合利奈唑胺治疗MRSA VAP患者疗效显著,可能通过抑制外周血PBMC中Notch信号通路而调节Th17、Treg分化,从而改善患者免疫功能,提高疗效。
    英文摘要:
          Abstract Objective: To study the effect of thymosin α1 combined with linezolid on immune function of methicillin-resistant Staphylococcus aureus ventilator-associated pneumonia (MRSA VAP) patients and Notch signaling pathway in peripheral blood mononuclear cells (PBMCs). Methods: A total of 124 MRSA VAP patients admitted in the Second Affiliated Hospital of Xingtai Medical College from June 2017 to March 2020 were divided into observation group (62 cases) and control group (62 cases) according to the method of random number table, among which the control group was treated with routine anti-inflammatory, supportive treatment and intravenous injection of linezolid, and the observation group was treated with thymosin α1 on the basis of the control group. The clinical efficacy, clinical indexes, respiratory mechanics indexes and levels of immune cells before and after treatment were compared between the two groups, and the expression of related mRNA in Notch signaling pathway in PBMCs was detected. Results: The total effective rate in observation group was higher than control group(95.16% vs 83.87%, P<0.05). The frequency of sputum suction, mechanical ventilation time and hospital stay in the observation group were significantly lower or shorter than those in the control group (P<0.05). The number of Tregsin the observation group was significantly higher than that in the control group after treatment, while that of Th17 cells was significantly lower than that of the control group (P<0.05). The expression levels of respiratory mechanics indexes (airway resistance, airway peak pressure, respiratory work) and related mRNA in Notch signaling pathway (Notch 1,Hey1, Hes1) were significantly decreased in both groups after treatment, and those in the observation group were significantly lower than those in the control group (P<0.05). Conclusion: Thymopeptide α1 combined with linezolid exerts curative effect on MRSA VAP patients, probably by regulating Th17 and Treg differentiation by inhibiting Notch signaling pathway in peripheral blood, thus improving immune function and therapeutic effect.