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大剂量盐酸氨溴索结合纤维支气管镜吸痰对重症肺炎患者血清可溶性髓系细胞触发受体1与降钙素原和可溶性CD163水平及肺功能的影响

Effects of high-dose ambroxol hydrochloride combined with fiberoptic bronchoscopy on serum soluble triggering receptor expressed on myeloid cells-1, procalcitonin, soluble CD163 levels and lung function in patients with severe pneumonia

作者：姚琳1于海翔1于涛1吕武2

英文作者：Yao Lin1 Yu Haixiang1 Yu Tao1 Lyu Wu2

单位：1辽宁省阜新市中心医院重症医学科123000；2辽宁省肿瘤医院中国医科大学肿瘤医院普外科，沈阳110041

英文单位：1Department of Critical Care Medicine Fuxin Central Hospital Liaoning Province Fuxin 123000 China; 2Department of General Surgery Liaoning Cancer Hospital Cancer Hospital of China Medical University Shenyang 110041 China

关键词：重症肺炎；盐酸氨溴索；纤维支气管镜；可溶性髓系细胞触发受体1；降钙素原；可溶性CD163

英文关键词：Severepneumonia;Ambroxolhydrochloride;Fiberopticbronchoscopy;Solubletriggeringreceptorexpressedonmyeloidcells-1;Procalcitonin;SolubleCD163

• 摘要：

• 目的 探究大剂量盐酸氨溴索结合纤维支气管镜吸痰对重症肺炎患者血清可溶性髓系细胞触发受体1（sTREM-1）、降钙素原、可溶性CD163（sCD163）水平及肺功能的影响。方法 选取2017年1月至2019年2月辽宁省阜新市中心医院呼吸内科收治的重症肺炎患者102例，采用随机数字表法分为对照组和观察组，各51例。对照组接受常规剂量盐酸氨溴索结合纤维支气管镜吸痰治疗，观察组接受大剂量盐酸氨溴索结合纤维支气管镜吸痰治疗，2组均治疗1周。观察并比较2组治疗前、治疗1周后血气分析指标、急性生理学与慢性健康状况评分系统Ⅲ（APACHE Ⅲ）评分、肺功能、氧化应激指标、血清sTREM-1、降钙素原、sCD163水平、临床症状改善时间及不良反应。结果 治疗1周后，2组血氧分压、氧合指数、第1秒用力呼气容积（FEV1）、用力肺活量（FVC）、FEV1占预计值百分比（FEV1%）和血清超氧化物歧化酶、总抗氧化能力水平均较治疗前升高，且观察组均高于对照组；而APACHE Ⅲ评分、丙二醛水平均较治疗前降低，且观察组均低于对照组（均P＜0.05）。治疗1周后，2组血清sTREM-1、降钙素原、sCD163水平均低于治疗前，且观察组均低于对照组［（29.8±2.6）ng/L比（35.3±2.2）ng/L、（1.6±0.4）μg/L比（2.2±0.8）μg/L、（57±11）ng/L比（78±13）ng/L］（均P＜0.05）。观察组退热、咳嗽消失、气促消失、肺部湿啰音消失时间均短于对照组（均P＜0.001）。2组不良反应发生率差异无统计学意义（P＞0.05）。结论 大剂量盐酸氨溴索结合纤维支气管镜吸痰可降低重症肺炎患者血清sTREM-1、降钙素原、sCD163水平，改善肺功能及血气分析指标，进而促进临床症状的消失，改善患者预后，且安全性较好。

• Objective To explore the effects of high-dose ambroxol hydrochloride combined with fiberoptic bronchoscopy on serum soluble triggering receptor expressed on myeloid cells-1(sTREM-1), procalcitonin (PCT), soluble CD163(sCD163) levels and lung function in patients with severe pneumonia. Methods From January 2017 to February 2019, 102 patients with severe pneumonia admitted to Department of Respiratory Medicine, Fuxin Central Hospital, Liaoning Province were enrolled. They were randomly divided into the control group and the observation group, with 51 cases in each group. The control group received routine dose of ambroxol hydrochloride combined with fiberoptic bronchoscopy for sputum aspiration and the observation group received high-dose ambroxol hydrochloride combined with fiberoptic bronchoscopy for sputum aspiration, and both groups were treated for 1 week. The blood gas analysis indexes and acute physiology and chronic health evaluation Ⅲ (APACHE Ⅲ) score, lung function, oxidative stress indexes, serum sTREM-1, PCT, sCD163 levels before and 1 week after treatment as well as clinical symptoms improved time and adverse reactions of the two groups were compared. Results After 1 week of treatment, the blood oxygen partial pressure, oxygenation index, forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), FEV1 as a percentage of expected value (FEV1%) and serum superoxide dismutase, total antioxidant capacity levels of the two groups were higher than those before treatment, and those of the observation group were higher than those of the control group; the APACHE Ⅲ score and malondialdehyde level of the two groups were lower than those before treatment, and those of the observation group were lower than those of the control group (all P<0.05). After 1 week of treatment, the levels of serum sTREM-1, PCT and sCD163 of the two groups were lower than those before treatment, and those of the observation group were lower than those of the control group［（29.8±2.6）ng/L vs （35.3±2.2）ng/L, （1.6±0.4）μg/L vs （2.2±0.8）μg/L, （57±11）ng/L vs （78±13）ng/L］（all P＜0.05）. The disappearance times of fever, cough, shortness of breath and pulmonary moist rales of the observation group were shorter than those of the control group (all P<0.001). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion High-dose ambroxol hydrochloride combined with fiberoptic bronchoscopy can reduce the serum sTREM-1, PCT and sCD163 levels in patients with severe pneumonia and improve lung function and blood gas analysis indexes, thereby promoting the disappearance of clinical symptoms and improving the prognosis of patients, with high safety.