莫西沙星治疗无铜绿假单胞菌危险因素老年慢性阻塞性肺疾病急性加重期的疗效研究

Clinical Study of Moxifloxacin in the Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Elderly Patients without Risk Factors of Pseudomonas aeruginosa Infection

摘要: 目的：探讨莫西沙星单药治疗无铜绿假单胞菌感染危险因素的慢性阻塞性肺疾病急性加重期患者的临床应用价值，评价其疗效和安全性。方法：采用随机、对照的研究方法，选取2018年12月至2020年1月于山西医科大学附属汾阳医院呼吸与危重症医学科及老年医学科住院的慢性阻塞性肺疾病急性加重期患者130例，随机分为实验组及对照组，分别在基础治疗，包括呼吸支持、糖皮质激素、支气管舒张剂及祛痰等辅助药物治疗上加用莫西沙星及阿莫西林/克拉维酸，治疗后评价其疗效及实验室指标。结果：临床疗效方面，实验组有效率81.5%，对照组有效率73.8%，差异无统计学意义(X²值1.110、P = 0.292)。实验室指标方面，治疗后白细胞计数实验组(6.78 ± 2.23) × 10⁹/L，对照组(7.81 ± 2.86) × 10⁹/L，差异有统计学意义(t值−2.282，P = 0.024)。治疗后的降钙素原实验组(0.154 ± 0.195) ng/ml，对照组(0.239 ± 235) ng/ml，差异有统计学意义(t值−2.240，P = 0.027)。存在II型呼吸衰竭患者PCO₂治疗前后变化值实验组(20.62 ± 6.40) mmHg优于对照组(13.93 ± 9.26) mmHg，差异有统计学意义(t值2.570、P = 0.015)。实验组FEV1/pred治疗后(63.59 ± 13.56)%，对照组(54.43 ± 12.57)%；差异有统计学意义(t值3.998、P < 0.001)。实验组FEV1/FVC治疗后(55.16 ± 8.76) %，对照组(51.26 ± 10.24)%，差异有统计学意义(t值2.335、P = 0.021)。抗生素使用时间及平均住院时间实验组[(6.75 ± 1.94)、(9.78 ± 2.40)]d均低于对照组[(8.85 ± 1.99)、(11.37 ± 2.56)]d，差异有统计学意义(t值−6.081、−3.679，均P < 0.001)。随访6个月内的急性加重情况，差异无统计学意义(X²值0.074、P = 0.785)。结论：莫西沙星可以用于治疗无铜绿假单胞菌感染危险因素的慢性阻塞性肺疾病急性加重期患者，有着更好的肺功能改善，更短的抗菌药物使用时间及住院时间，在合并II型呼吸衰竭亚组中更有优势，安全性好。

Abstract: Objective: To evaluate the efficacy and safety of moxifloxacin monotherapy in patients with acute exacerbation of chronic obstructive pulmonary disease without risk factors of Pseudomonas aeruginosa infection. Methods: A total of 130 patients with acute exacerbation of chronic obstructive pulmonary disease who were hospitalized in Department of Respiratory and Critical Care Medicine and Department of Geriatrics, Affiliated Fenyang Hospital of Shanxi Medical University from December 2018 to January 2020 were randomly divided into experimental group and control group, who received basic treatment respectively. Moxifloxacin and amoxicillin/clavulanate were added to respiratory support, systemic corticosteroids, bronchodilators, expectorants and other adjuvant medications. The efficacy and laboratory indicators were evaluated after treatment. Results: In terms of clinical efficacy, the effective rate was 81.5% in the experimental group and 73.8% in the control group, the difference was not statistically significant (X² = 1.110, P = 0.292). In terms of laboratory indicators, the white blood cell count in the experimental group after treatment was (6.78 ± 2.23) × 10⁹/L, control group (7.81 ± 2.86) × 10⁹/L, the difference was statistically significant (t value −2.282, P = 0.024). Procalcitonin group after treatment (0.154 ± 0.195) ng/ml, control group (0.239 ± 235) ng/ml, the difference was statistically significant (t value −2.240, P = 0.027). The change of PCO₂ in patients with II type respiratory failure before and after treatment in the experimental group (20.62 ± 6.40) mmHg was better than that in the control group (13.93 ± 9.26) mmHg, the difference was statistically significant (t value 2.570, P = 0.015). After treatment, FEV1/pred was (63.59 ± 13.56)% in the experimental group and (54.43 ± 12.57)% in the control group. The difference was statistically significant (t value 3.998, P < 0.001). In the experimental group, FEV1/FVC was (55.16 ± 8.76)% after treatment, control group (51.26 ± 10.24)%, the difference was statistically significant (t value 2.335, P = 0.021). The duration of antibiotic use and average length of hospital stay in the experimental group [(6.75 ± 1.94), (9.78 ± 2.40)]d were lower than those in the control group [(8.85 ± 1.99), (11.37 ± 2.56)]d. The difference was statistically significant (t value −6.081, −3.679, all P < 0.001). There was no significant difference in acute exacerbation during the follow-up period of 6 months (X² = 0.074, P = 0.785). Conclusion: Moxifloxacin can be used to treat patients with acute exacerbation of COPD without risk factors for Pseudomonas aeruginosa infection, with the better improvement of lung function, shorter duration of antibiotic use and hospital stay. It is more advantageous in the subgroup of combined II type respiratory failure and has good safety.