不同剂量替加环素治疗CR-KP肺炎效果研究OA
Efficacy of different doses of tigecycline in the treatment of CR-KP pneumonia
目的 观察不同剂量替加环素治疗耐碳青霉烯肺炎克雷伯菌(CR-KP)肺炎的临床效果.方法 开展前瞻性、随机、对照研究,选取2021年5月至2023年6月河南省驻马店市中心医院收治的CR-KP肺炎患者96例作为研究对象,采用电脑随机分组法分为常规组和大剂量组,每组48例.2组均采用替加环素治疗,常规组按每次50 mg、每12小时用药1次的常规疗法治疗,大剂量组按每次100 mg、每12小时用药1次的大剂量用药方案治疗.比较2组患者疗效、预后情况和治疗安全性.结果 大剂量组患者治疗后细菌清除率[93.75%(45/48)]略高于常规组[87.50%(42/48)],细菌替换率[8.33%(4/48)]、细菌再感染率[4.17%(2/48)]、28 d病死率[2.08%(1/48)]、高迁移族蛋白B1[(20.33±5.16)ng/L]、可溶性髓系细胞触发受体-1[(102.45±20.77)μg/L]、C反应蛋白[(7.62±1.38)mg/L],以及T淋巴细胞亚群CD3+[(65.33±10.27)%]、CD4+[(42.25±10.31)%]、CD4+/CD8+(2.11±0.46)与常规组[分别为10.42%(5/48)、8.33%(4/48)、6.25%(3/48)、(21.45±5.36)ng/L、(105.46±20.74)μg/L、(8.02±1.77)mg/L、(62.44±10.61)%、(40.35±10.33)%、1.95±0.78]比较,差异均无统计学意义(P>0.05);大剂量组患者住院时间[(35.25±5.18)d]明显长于常规组[(32.44±5.16)d],替加环素相关不良反应发生率[20.83%(10/48)]明显高于常规组[4.17%(2/48)],差异均有统计学意义(P<0.05).结论 替加环素对减轻CR-KP肺炎患者炎症反应、改善机体免疫功能均具有积极作用;与常规剂量比较,大剂量替加环素的细菌清除率更高,但增加剂量可能增加药物不良反应发生风险,并延长住院周期.
Objective To compare the clinical efficacy and safety of different doses of tigecycline in the treatment of Carbapenem resistant Klebsiella pneumoniae(CR-KP)pneumonia.Methods A total of 96 pa-tients with CR-KP pneumonia admitted to Zhumadian Central Hospital,Henan Province,from May 2021 to June 2023 were enrolled in this prospective,randomized,controlled study.They were randomly assigned via computer-generated sequence to either the standard-dose group(n=48,tigecycline 50 mg every 12 hours)or the high-dose group(n=48,tigecycline 100 mg every 12 hours).Treatment efficacy,prognostic outcomes,and safety were compared between the two groups.Results The bacterial clearance rate in the high-dose group was 93.75%(45/48),numerically higher than that in the standard-dose group[87.50%(42/48)],without reaching statistical significance(P>0.05).No significant differences were found between the two groups in the following outcomes(P>0.05):bacterial replacement rate[8.33%(4/48)in the high-dose vs.10.42%(5/48)in the standard-dose group],bacterial reinfection rate[4.17%(2/48)vs.8.33%(4/48)],and 28-day mortality[2.08%(1/48)vs.6.25%(3/48)].Furthermore,no significant intergroup differences were ob-served in post-treatment inflammatory markers,including high-mobility group box 1 protein[(20.33±5.16)ng/L vs.(21.45±5.36)ng/L],soluble triggering receptor expressed on myeloid cells-1[(102.45±20.77)μg/L vs.(105.46±20.74)μg/L],and C-reactive protein[(7.62±1.38)mg/L vs.(8.02±1.77)mg/L],or in T-lymphocyte subsets CD3+[(65.33±10.27)%vs.(62.44±10.61)%],CD4+[(42.25±10.31)%vs.(40.35±10.33)%],and the CD4+/CD8+ratio(2.11±0.46 vs.1.95±0.78).However,the high-dose group had a sig-nificantly longer hospital stay[(35.25±5.18)d vs.(32.44±5.16)d,P<0.05]and a significantly higher inci-dence of tigecycline-related adverse reactions[20.83%(10/48)vs.4.17%(2/48),P<0.05].Conclusion Tigecy-cline is an effective treatment for reducing inflammation and improving immune function in patients with CR-KP pneumonia.Compared with the standard-dose,high-dose tigecycline has a higher bacterial clearance rate,but increasing the dose may increase the risk of drug side effects and prolong hospitalization.
申国庆;王运;刘辉;甘文云;徐敬敬;麻恒翔;王文娟
驻马店市中心医院呼吸重症医学科,河南 驻马店 463000驻马店市中心医院呼吸重症医学科,河南 驻马店 463000驻马店市中心医院呼吸重症医学科,河南 驻马店 463000驻马店市中心医院呼吸重症医学科,河南 驻马店 463000驻马店市中心医院呼吸重症医学科,河南 驻马店 463000驻马店市中心医院呼吸重症医学科,河南 驻马店 463000南阳市第一人民医院重症监医学科,河南 南阳 473000
医药卫生
耐碳青霉烯肺炎克雷伯菌肺炎替加环素用药剂量治疗结果
Carbapenem resistant Klebsiella pneumoniae pneumoniaTigecyclineDrug dosageTreatment outcome
《现代医药卫生》 2026 (1)
53-57,5
河南省医学科技攻关项目(LHGJ202001327).
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