Efficacy of ambroxol combined with amikacin in treatment of patients with COPD complicated with ventilator-associated pneumonia
Shen Yixuan
Yue Jianhong
Li Mingzhu
Zhu Jiafeng
Fan Yuanyuan
Li Fei
Du Lei
Abstract：Objective To investigate the effects of ambroxol hydrochloride combined with amikacin on NOD-like receptor heat protein domain associated protein 3(NLRP3)inflammasome and its downstream inflammatory factors and prognosis in patients with chronic obstructive pulmonary disease(COPD)complicated with ventilator-associated pneumonia(VAP).Methods A to-tal of 108 patients with COPD complicated with VAP admitted to Northwest Women's and Children's Hospital from April 2019 to April 2022 were selected as the research subjects and divided into the control group and observation group by random number table method,with 54 in each group.All the patients in both groups received routine oxygen inhalation and sputum aspiration by fiberoptic bronchoscope.The patients in the control group were given atomized amicacin inhalation and the expectorant drug brohexine.Am-broxol hydrochloride was added in those patients in the observation group.Clinical efficacy,adverse effects,NLRP 3 inflammasome and its downstream inflammatory factors(NLRP 3,Caspase-1(CRP-1)mRNA and protein expression),arterial blood gas indexes(arterial carbon dioxide partial pressure(PaCO2),arterial oxygen partial pressure(PaO2),arterial oxygen saturation(SaO2)),and prog-nosis indicators(clinical pulmonary infection score(CPIS),pulmonary infection control time,emergency hospital stay,mechanical ventilation time)were determined and compared between the two groups.Results The total effective rate of the observation group(94.44%)was higher than that of the control(75.93%)(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(20.37%vs 16.67%)(P>0.05).Meanwhile,no ototoxicity,nephrotoxicity or neuromuscular side effects occurred in both groups.After treatment,the levels of Caspase-1 mRNA,NLRP3 mRNA,Caspase-1 protein,NLRP3 protein,TNF-α and IL-1β were(19.66±0.98),(17.80±0.90),(0.31±0.06),(0.30±0.05),(31.50±3.24)pg·mL-1,(16.40±1.90)pg·mL-1,respective-ly,which were significantly lower than those of(23.15±1.06),(22.04±1.07),(0.43±0.09),(0.50±0.10),(45.34±4.55)pg·mL-1,(22.67±2.39)pg·mL-1 in the control,and there were significant differences between the two groups(t=17.765,22.284,8.152,13.145,18.208,15.091,all P<0.05).The value of PaCO2 was(40.00±6.03)mm Hg in the observation group,which was lower than that of(45.57±6.50)mm Hg in the control group,and the values of PaO2 and SaO2 were(74.70±7.35)mm Hg and(95.98±5.14)%in the observa-tion group,which were higher than those of(66.00±6.10)mm Hg and(90.30±4.71)%in the control group(t=4.616,6.693,5.987,all P<0.05).CPIS,pulmonary infection control time,emergency hospital stay,mechanical ventilation time in the observation group were(4.10±1.21)points,(7.60±1.40)d,(4.25±1.40)d and(3.66±1.30)d,respectively and they were lower than those in the control group((7.50±1.52)points,(10.02±2.10)d,(7.20±2.81)d,(6.58±2.10)d),with statistically significant differences(t=12.860,7.046,6.905,8.688,all P<0.05).Conclusion The combined use of ambroxol hydrochloride and amikacin is effective in treatment of COPD complicated with VAP since it can inhibit NLRP 3 inflammasome activation and inflammatory response mediated by downstream in-flammatory factors to improve arterial blood gas and prognosis.Meanwhile,this regimen is of high safety.
Keywords：Ambroxol hydrochlorideAmikacinChronic obstructive pulmonary diseaseVentilator-associated pneumoniaNOD-like receptor heat protein domain associated protein 3 inflammasomeInflammatory factorPrognosis
Publication Date：2025-08-25
Online Publishing Date：2025-09-01(First online date of this platform, not the publication date of the document)
Pages：5( 824-828 )