2024 年第 8 期 第 19 卷

哌拉西林他唑巴坦联合盐酸氨溴索治疗慢性阻塞性肺疾病急性加重期的效果及对患者血清可溶性CD40配体和基质金属蛋白酶9水平的影响

The effect of piperacillin tazobactam combined with ambroxol hydrochloride in the treatment of acute exacerbation of chronic obstructive pulmonary disease and its impact on patients′ serum soluble CD40 ligand and matrix metalloproteinase 9 levels

作者：陈文灯1郑向真1卢蔚薇2

英文作者：Chen Wendeng1 Zheng Xiangzhen1 Lu Weiwei2

单位：1中国人民解放军联勤保障部队第九〇九医院厦门大学附属东南医院呼吸内科，漳州363000；2中国人民解放军联勤保障部队第九〇九医院厦门大学附属东南医院儿科，漳州363000

英文单位：1Department of Respiratory Medicine Southeast Hospital Affiliated to Xiamen University 909th Hospital of the Joint Logistics Support Force of the Chinese People′s Liberation Army Zhangzhou 363000 China; 2Department of Pediatrics Southeast Hospital Affiliated to Xiamen University 909th Hospital of the Joint Logistics Support Force of the Chinese People′s Liberation Army Zhangzhou 363000 China

关键词：慢性阻塞性肺疾病；急性加重期；哌拉西林他唑巴坦；盐酸氨溴索；可溶性CD40配体；基质金属蛋白酶9

英文关键词：Chronicobstructivepulmonarydisease;Acuteexacerbationstage;Piperacillintazobactam; Ambroxolhydrochloride;SolubleCD40ligand;Matrixmetalloproteinase9

• 摘要：

• 目的 探讨哌拉西林他唑巴坦联合盐酸氨溴索治疗慢性阻塞性肺疾病（COPD）急性加重期(AECOPD)的效果及对患者血清可溶性CD40配体（sCD40L）和基质金属蛋白酶9（MMP-9）水平的影响。方法 选择2022年3月至2023年4月中国人民解放军联勤保障部队第九〇九医院收治的AECOPD患者95例。按照随机数字表法将患者分为观察组（48例）和对照组（47例）。对照组在常规治疗基础上给予哌拉西林他唑巴坦静脉滴注治疗，观察组在常规治疗基础上给予盐酸氨溴索联合哌拉西林他唑巴坦静脉滴注治疗，均连续治疗7 d。比较2组临床疗效，治疗前后肺功能、血气指标以及血清sCD40L、MMP-9水平变化情况，治疗后不良反应发生情况。结果 观察组总有效率高于对照组［95.8%（46/48）比80.9%（38/47）］，差异有统计学意义（P<0.05）。治疗后观察组肺功能指标第1秒用力呼气容积（FEV1）、FEV1与用力肺活量比值以及FEV1占预计值百分比，血气分析指标动脉血氧分压、pH值均明显高于对照组，动脉血二氧化碳分压明显低于对照组，差异均有统计学意义（均P<0.05）。治疗后观察组患者血清sCD40L、MMP-9水平均明显低于对照组，差异均有统计学意义（均P<0.05）。2组不良反应发生率比较差异无统计学意义（P>0.05）。结论 哌拉西林他唑巴坦联合盐酸氨溴索治疗AECOPD患者效果显著，可改善患者肺功能以及血气分析结果，降低患者血清sCD40L、MMP-9水平，其机制与其能有效控制炎症反应以及抑制气道重塑有关。

• Objective To explore the effect of piperacillin tazobactam combined with ambroxol hydrochloride in the treatment of acute exacerbation of chronic obstructive pulmonary(AECOPD) disease and its impact on patients′ serum soluble CD40 ligand(sCD40L) and matrix metalloproteinase 9(MMP-9) levels. Methods  A total of 95 AECOPD patients admitted to the 909th Hospital of the Joint Logistics Support Force of the Chinese People′s Liberation Army from March 2022 to April 2023 were selected. According to the random number table method, patients were divided into observation group(48 cases) and control group(47 cases). The control group received intravenous infusion of piperacillin tazobactam on the basis of routine treatment, while the observation group received intravenous infusion of ammonium bromide hydrochloride combined with piperacillin tazobactam on the basis of routine treatment, both of which were treated continuously for 7 d. The clinical efficacy of the two groups, changes in lung function, blood gas indicators, serum sCD40L and MMP-9 levels before and after treatment, and incidence of adverse reactions after treatment were compared. Results  The total effective rate of the observation group was higher than that of the control group ［95.8%(46/48) vs 80.9%(38/47)］(P<0.05). After treatment, the lung function indicators forced expiratory volume in the first second(FEV1), FEV1 to forced vital capacity ratio, FEV1 as a percentage of expected value, and blood gas analysis indicators arterial partial pressure of oxygen and pH in the observation group were significantly higher than those in the control group, while arterial carbon dioxide partial pressure was significantly lower than that in the control group(all P<0.05). After treatment, the average levels of serum sCD40L and MMP-9 in the observation group were significantly lower than those in the control group(all P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusions  The combination of piperacillin tazobactam and ambroxol hydrochloride has a significant therapeutic effect on AECOPD patients. It can improve lung function and blood gas analysis results, reduce serum sCD40L and MMP-9 levels, and its mechanism is related to effective control of inflammatory response and inhibition of airway remodeling.