老年慢性阻塞性肺疾病急性加重期治疗中血清降钙素原的作用

The predicting value of serum procalcitonin in treatment of acute exacerbations of chronic obstructive pulmonary disease in elderly patients

目的研究血清降钙素原（PCT）在老年慢性阻塞性肺疾病急性加重（AECOPD）患者治疗中的作用。方法选取住院的老年AECOPD患者267例，分为常规治疗组135例（常规组）和PCT指导治疗组132例（PCT组）。常规组由经治医师按抗生素使用指南决定抗生素治疗方案，PCT组按血清PCT水平决定是否使用抗生素。观察两组患者的住院时间、临床有效率、住院费用及抗生素费用、抗生素使用率、住院病死率、1年随访期间AECOPD发生率、发生次数及住院率。结果两组患者在住院时间、临床有效率、住院病死率及1年随访期间AECOPD发生率、发生次数及住院率差异无统计学意义（均为P〉0．05），PCT组的住院费用、抗生素费用及抗生素使用率[分别为10882（3808-16651）元、6934（2390-10660）元、76．5％]均低于常规组[分别为13637（4650～19730）元、8589（3144～12117）元、87．4％]（均为P〈0．05）。结论与常规治疗相比，老年AECOPD患者在PCT指导下使用抗生素可以减少抗生素使用量，降低住院费用。

Objective To evaluate the predicting value of serum procalcitonin （PCT） in treatment of acute exacerbations of chronic obstructive pulmonary disease （AECOPD） in elderly patients. Methods A total of 267 elderly patients requiring hospitalization for AECOPD were randomly assigned into 2 groups： standard therapy group （standard group, n= 135） and PCT-guided group（PCT group, n= 132）. Standard group received antibiotics according to the guideline of attending physicians and PCT group were treated with antibiotics according to serum PCT levels. Length of hospitalization, clinical efficacy, costs of hospitalization and antibiotics, rate of antibiotics use, hospital mortality, rate of exacerbation and rehospitalization, frequency of exacerbation within 1 year were observed. Results Length of hospitalization, clinical efficacy, hospital mortality, rate of exacerbation and rehospitalization, frequency of exacerbation within 1 year were similar in 2 groups（all P〉 0.05）; costs of hospitalization and antibiotics, rate of antibiotics use of PCT group [10 882 （3808-16 651）yuan, 6934 （ 2390-10 660）yuan, 76.5%] were lower than those of standard group [3 637（4650-19 730）yuan, 8589（3144- 12 117）yuan, 87.4%] （all P〈0.05）. Conclusions PCT guidance offers an advantage over standard therapy in reducing antibiotic use and in lowering the costs of hospitalization in treatment of AECOPD in elderly patients.