丙氨酰谷氨酰胺辅助抗菌药物治疗提高重症肺炎疗效及对肺表面活性蛋白-A、肺表面活性蛋白-D和体液免疫的影响

Alanylglutamine-assisted Antimicrobial Agent Treatment Improves the Efficacy of Severe Pneumonia and Its Effect on SP-A, SP-D and Humoral Immunity

关键词:  丙氨酰谷氨酰胺  抗菌药物  重症肺炎患者  血气分析  体液免疫

Key words:  alanylglutamine  antimicrobial agent  severe pneumonia patients  blood gas analysis  humoral immunity

摘要:

目的 探究丙氨酰谷氨酰胺与抗菌药物联合治疗对重症肺炎患者肺表面活性蛋白-A （pulmonary surfactant protein-A，SP-A）、肺表面活性蛋白-D （pulmonary surfactant protein-D，SP-D）及体液免疫的影响。方法 选择2016年1月—2018年12月在南京市中西医结合医院接受治疗的重症肺炎患者97例为研究对象，按照随机数字表法分为观察组（n=51）和对照组（n=46），对照组接受抗菌药物治疗（美罗培南），观察组在对照组的基础上静脉注射丙氨酰谷氨酰胺进行治疗。比较2组患者的临床总有效率、动脉血氧分压（arterial partial pressure of oxygen，PaO₂）、二氧化碳分压（partial pressure of carbon dioxide，PaCO₂）、血氧饱和度（oxygen saturation，SpO₂）、SP-A、SP-D、免疫球蛋白A （immunoglobulin A，IgA）、免疫球蛋白M （immunoglobulin M，IgM）、免疫球蛋白G （immunoglobulin G，IgG）水平及不良反应发生情况。结果 观察组总有效率明显高于对照组（P<0.05）；2组患者的PaO₂、SpO₂值明显高于治疗前（P<0.05），且观察组的PaO₂、SpO₂值明显高于对照组（P<0.05），2组患者的PaCO₂值明显低于治疗前（P<0.05），且观察组的PaCO₂值明显低于对照组（P<0.05）；2组患者的SP-A、SP-D水平明显高于治疗前（P<0.05），且观察组的SP-A、SP-D水平明显高于对照组（P<0.05）；2组患者IgA、IgG、IgM水平明显高于治疗前（P<0.05），且观察组IgA、IgG水平明显高于对照组（P<0.05），对照组IgM水平明显高于观察组（P<0.05）；治疗后，对照组有2例患者出现呕吐症状、3例患者出现腹泻等症状；观察组未发现不良反应。结论 丙氨酰谷氨酰胺与抗菌药物联合治疗能改善重症肺炎患者的氧合能力，提高患者的免疫力，抑制炎症反应的发生。

Abstract:

OBJECTIVE To explore the effects of alanylglutamine combined with antimicrobial agent on pulmonary surfactant protein-A(SP-A), pulmonary surfactant protein-D(SP-D) and humoral immunity in patients with severe pneumonia. METHODS A total of 97 patients with severe pneumonia treated in Nanjing Integrated Traditional Chinese and Western Medicine Hospital from January 2016 to December 2018 were selected as subjects of study, the patients were divided into observation group(n=51) and control group(n=46) according to the method of random number table, the control group received antimicrobial agent treatment(meropenem), the observation group was treated with alanylglutamine intravenously on the basis of the control group. To compare the clinical total effective rate, arterial partial pressure of oxygen(PaO₂), partial pressure of carbon dioxide(PaCO₂) and oxygen saturation(SpO₂), SP-A, SP-D, immunoglobulin A(IgA), immunoglobulin M(IgM) and immunoglobulin G(IgG) and adverse reactions occur. RESULTS The total effective rate of the observation group was significantly higher than that of the control group(P<0.05). The PaO₂ and SpO₂ values of the two groups were significantly higher than those before treatment(P<0.05), and the PaO₂ and SpO₂ values of the observation group were significantly higher than those of the control group(P<0.05). The PaCO₂ values of the two groups were significantly lower than those before treatment(P<0.05), and the PaCO₂ values of the observation group were significantly lower than those of the control group(P<0.05). The levels of SP-A and SP-D in the two groups were significantly higher than those before treatment(P<0.05), and the levels of SP-A and SP-D in the observation group were significantly higher than those in the control group(P<0.05). The levels of IgA, IgG and IgM in the two groups were significantly higher than those before treatment(P<0.05), and the levels of IgA and IgG in the observation group were significantly higher than those in the control group(P<0.05), while the levels of IgM in the control group were significantly higher than those in the observation group(P<0.05). After treatment, 2 patients in the control group developed vomiting symptoms and 3 patients developed diarrhea. No adverse reactions were found in the observation group. CONCLUSION The combined treatment of alanylglutamine and antimicrobial agent can improve the oxygenation ability of severe pneumonia patients, improve their immunity and inhibit the occurrence of inflammatory reaction.