血清降钙素原测定在慢性阻塞性肺疾病急性加重期治疗中的意义

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

目的研究血清降钙素原（PCT）检测在慢性阻塞性肺疾病急性加重（AECOPD）患者治疗时抗生素使用中的临床意义。方法选取2004年5月至2006年12月间收治入院的AECOPD患者235例，随机分配为常规治疗组117例（A组）和PCT指导治疗组118例（B组），入院后即用荧光增强发射法检测血清PCT水平。在相同常规治疗基础上，A组由经治医师按照抗生素使用指南决定抗生素治疗方案，B组按照血清PCT水平决定是否使用抗生素，在血清PCT≥0．25ng／ml时，进行抗生素治疗，PCT〈0．25ng／ml时，不予抗生素治疗。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发生率及住院率。采用t检验、Mann—Whitney U检验及χ^2检验进行统计学分析。结果两组患者在临床有效率、住院病死率、住院时间及1年随访期间AECOPD发生率及住院率方面差异无统计学意义（P分别为0．635、0．768、0．884、0．747和0．727），PCT指导治疗组的抗生素费用、住院费用及抗生素使用率均低于常规治疗组（P分别为0．029，0．036和0．014）。结论AECOPD患者人院之初可以进行PCT水平检测以指导抗生素使用，能够降低抗生素使用率，减少用于抗生素使用的费用和总的住院费用。

Objective To evaluate the value of serum procalcitonin（PCT）on antibiotics use in treatment of acute exacerbations of chronic obstructive pulmonary disease（AECOPD）. Method From May 2004 to December 2006, a total of 235 patients requiring hospitalization for AECOPD were randomly assigned into two groups： standard therapy group（ group A, n = 117） and PCT-guided group（ group B, n = 118）. PCT levels of all patients were meastared after hospital admission by an amplified cryptate emission technology assay. On the base of similarly normal treatment, group A received antibiotics according to the attending physicians, and group B were treated with antibiotics according to serum PCF levels： antibiotic treatment was applied with PCT level ≥ 0.25 ng/ml and was discouraged with PCT level 〈 0.25 ng/mh Length of hospitalization, chnical efficacy, costs of hospitalization and antibiotics, rate of antibiotics use, hospital mortality, rate of exacerbation and rehospitalization within 1 year were observed. Analyses were performed by t test, Mann-Whitney U test or χ^2 test. Results Clinical efficacy, hospital mortality, length of hospitalization, rate of exacerbation and rehospitalization within 1 year were similar in two groups （ P = 0. 635,0. 768,0. 884,0. 747,0. 727） ; costs of antibiotics and hospitalization, rate of antibiotics use of PCT- guided group were lower than that of standard therapy group（ P = 0. 029,0. 036, 0. 014）. Conclusions PCT could be, used in treatment of AECOPD for antibiotic use after hospital admission, which may reduce antibiotic use and lower costs of antibiotic and hospitalization.