目的 探究亚胺培南西司他丁（IPM/CS）联合胸腺法新治疗老年重症肺炎（SP）的疗效，并分析其对患者肺氧合功能及血清可溶性血红蛋白清道夫受体163（sCD163）、可溶性CD40配体（sCD40L）、淀粉样蛋白A（SAA）水平的影响。 方法 按照随机数字表法将康复大学青岛中心医院2024年1月至2025年8月收治的102例老年SP患者分为研究组（IPM/CS+胸腺法新）51例与对照组（IPM/CS单用）51例。治疗2周后评估各组疗效，记录对比各组患者症状体征消退时间、治疗前后肺部感染评分（CPIS）、肺氧合功能［外周血氧饱和度（SpO₂）、动脉血氧分压（PaO₂）、氧合指数（OI）］、免疫功能（CD3⁺、CD4⁺、CD4⁺/CD8⁺）、血清C反应蛋白（CRP）、sCD163、sCD40L、SAA水平及不良反应。 结果 研究组治疗总有效率为94.12%，高于对照组的80.39%（P < 0.05），症状体征消退时间早于对照组（P < 0.05）；对比治疗前，两组治疗后CPIS评分、血清CRP、sCD163、sCD40L、SAA水平均下降，SpO₂、PaO₂、OI、CD3⁺、CD4⁺、CD4⁺/CD8⁺均上升，且研究组上述指标下降或上升程度均大于对照组，差异均有统计学意义（P < 0.05）。两组不良反应对比差异无统计学意义（P > 0.05）。 结论 IPM/CS联合胸腺法新治疗老年SP安全有效，能有效改善患者肺氧合功能及免疫功能，下调血清sCD163、sCD40L、SAA水平，缩短症状体征消退时间。

Objective To explore the efficacy of imipenem/cilastatin （IPM/CS） in combination with thymalfasin in the treatment of elderly patients with severe pneumonia （SP）， and to analyze its impact on the pulmonary oxygenation function and the levels of serum soluble hemoglobin scavenger receptor 163 （sCD163）， soluble CD40 ligand （sCD40L）， and amyloid A （SAA） in these patients. Methods A total of 102 elderly patients with SP （senile pneumonia， presumably， though not clearly defined in this context） who were admitted to Qingdao Central Hospital， University of Health and Rehabilitation Sciences between January 2024 and August 2025 were randomly divided into the study group （n = 51， treated with IPM/CS + thymalfasin） and the control group （n = 51， treated with IPM/CS） using the random-number table method. The therapeutic effects were evaluated two weeks after the treatment. The regression time of symptoms and signs， the clinical pulmonary infection score （CPIS） before and after treatment， pulmonary oxygenation function ［including peripheral blood oxygen saturation （SpO2）， arterial partial pressure of oxygen （PaO2）， and oxygenation index （OI）］， immune function （CD3⁺， CD4⁺， CD4⁺/CD8+）， serum levels of C-reactive protein （CRP）， sCD163， sCD40L， SAA， and adverse reactions were recorded and compared. Results The study group exhibited a higher total effective rate （94.12% vs. 80.39%） （P < 0.05）， along with an earlier regression time of symptoms and signs （P < 0.05）. When compared with the pre-treatment values， the CPIS score， serum CRP， sCD163， sCD40L， and SAA levels in both groups decreased after treatment， whereas SpO₂， PaO₂， OI， CD3⁺， CD4⁺， and CD4⁺/CD8⁺ increased. Furthermore， the extent of decrease or increase in the above-mentioned indicators in the study group was more significant than that in the control group， and these differences were statistically significant （P < 0.05）. There was no significant difference in adverse reactions between the two groups （P > 0.05）. Conclusions The treatment of elderly patients with SP using IPM/CS in combination with thymalfasin is both safe and effective. This treatment approach can effectively enhance the pulmonary oxygenation function and immune function of patients， reduce the levels of serum sCD163， sCD40L and SAA， and shorten the regression time of symptoms and signs.