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目的:探究乌司他丁结合利奈唑胺治疗重症肺炎的效果，及其对肺泡灌洗液微小RNA-4455(miR-4455)、微小RNA-1323(miR-1323)表达的影响。方法:抽取2018年4月至2020年4月平顶山市第二人民医院收治的重症肺炎患者104例，采用简单随机法分为研究组和对照组，每组52例。两组均行常规治疗，于此基础上，对照组予以利奈唑胺，研究组予以乌司他丁结合利奈唑胺，均治疗2周。比较两组疗效、治疗前后急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、临床肺部感染评分(CPIS)、血气指标[动脉血二氧化碳分压(PaCOn 2)、动脉血氧分压(PaOn 2)、血氧饱和度(SaOn 2)]、肺泡灌洗液miR-4455、miR-1323表达情况。n 结果:研究组治疗总有效率(92.31%，48/52)高于对照组(75.00%，39/52)，n P<0.05。治疗后，研究组APACHEⅡ、CPIS评分低于对照组(n P<0.05)；PaCOn 2水平低于对照组，PaOn 2、SaOn 2水平高于对照组(n P<0.05)；肺泡灌洗液miR-4455表达低于对照组，miR-1323表达高于对照组(n P<0.05)。n 结论:乌司他丁结合利奈唑胺治疗重症肺炎，能进一步调节肺泡灌洗液miR-4455、miR-1323水平，从而减轻病情程度，显著提高疗效。“,”Objective:To investigate the curative effect of ulinastatin combined with linezolid in the treatment of severe pneumonia, and its effect on the expression of microRNA-4455 (miR-4455) and microRNA-1323 (miR-1323) in alveolar lavage fluid.Methods:A total of 104 patients with severe pneumonia in the Second People’s Hospital of Pingdingshan from April 2018 to April 2020 were selected and divided into study group and control group by simple randomization, with 52 cases in each group. Both groups received conventional treatment. Additionally, on this the control group was treated with linezolid, and the study group with ulinastatin combined with linezolid. All of them were treated for 2 weeks. The efficacy, acute physiology and chronic health status scoring system Ⅱ (APACHE Ⅱ) score, clinical pulmonary infection score (CPIS), blood gas index, such as arterial blood carbon dioxide partial pressure (PaCOn 2), arterial blood oxygen partial pressure (PaOn 2), blood oxygen saturation (SaOn 2), and the expression of alveolar lavage fluid miR-4455 and miR-1323 before and after treatment were compared between the two groups.n Results:The total effective rate of treatment in the study group (92.31%, 48/52) was higher than that in the control group (75.00%, 39/52), n P<0.05. After treatment, the APACHEⅡ score and CPIS of the study group were lower than those of the control group (n P<0.05). PaCOn 2 level in the study group was lower than that in the control group after treatment, and PaOn 2 and SaOn 2 levels were higher than those in the control group (n P<0.05). After treatment, the expression of miR-4455 in the alveolar lavage fluid of the study group was lower than that of the control group, and the expression of miR-1323 was higher than that of the control group (n P<0.05).n Conclusions:Ulinastatin combined with linezolid in the treatment of severe pneumonia can further improve the patient’s immune function and regulate the levels of alveolar lavage fluid miR-4455 and miR-1323, thereby reducing the degree of illness and significantly improving the efficacy.