血清降钙素原水平对指导慢性阻塞性肺疾病急性加重期抗菌治疗策略价值的研究

Study of serum procalcitonin level on the strategy value of antibiotic treatment in patients with acute exacerbation of chronic obstructive pulmonary disease

目的评价降钙素原(procalcitonin,PCT)指导抗菌治疗策略在慢性阻塞性肺疾病急性加重期(acute exacerbations of chronic obstructive pulmonary disease,AECOPD)优化抗生素使用中的价值。方法2006年9月至2007年8月在我院老年呼吸内科和呼吸病特色诊疗中心入选56例AECOPD患者(入选标准为当日血清PCT>0.25μg/L),随机分成PCT组(n=26)和常规治疗组(n=30)。PCT组于第1天、第5天、第7天和第10天检测PCT水平,根据血清PCT水平决定抗生素的使用,如PCT<0.25μg/L停用抗生素;常规治疗组根据患者临床症状决定抗生素的使用。同时进行痰细菌学的检查以及其他实验室指标如血白细胞计数、C-反应蛋白等。主要观察指标为抗生素的使用天数、住院时间、临床有效率、功能状态评分,加重例数以及死亡例数等。结果PCT组的抗生素使用天数多分布在7～10d;而常规治疗组大部分在两周甚至更长,差异有统计学意义(P<0.01),两组患者住院天数(P<0.01)和二重感染发生例数(P<0.05)相比差异有统计学意义,两组临床有效率、功能状态评分、病死率、加重例数差异无统计学意义(P>0.05)。结论PCT具有指导AECOPD抗菌治疗的作用,能够减少抗生素过度使用,降低二重感染机会。

Objective To evaluate the value of serum procalcitonin level in guiding the optimization use of antibiotics in patients with acute exacerbation of chronic obstructive pulmonary disease.Methods From September 2006 to August 2007 in the department of geriatric respiratory medicine and the characteristic clinic Center of Respiratory disease,56 hospitalized acute exacerbation of chronic obstructive pulmonary disease(AECOPD) patients with serum PCT>0.25 μg/L were randomized into PCT group (n=26) and conventional treatment group(n=30).In PCT group,at 1,5,7 and 10 day,Serum PCT level were assessed,patients received antibiotics according to the level of serum PCT,if PCT<0.25 μg/L,antibiotics were suspended in conventional treatment group,patients received antibiotics according to the clinical experience of attending physicians.At the same time,the sputum bacteriology and other laboratory indicators such as white blood cell count,C-reactive protein were investigated.Days of antibiotics use and hospitalization,clinical efficiency,functional status score,the incidence of Secondary infection,the number of aggravated cases and deaths were analyzed.Results In PCT Group,the days of antibiotics use mostly distribute in 7-10 days and the conventional treatment group in two weaks and more longer,The difference was significant(P<0.01),In two group,hospitalization(P<0.01),and the incidence of secondary infection(P<0.05) were significant different,the clinical efficiency,functional status score,mortality and aggravated cases in two groups was no significant difference(P>0.05).Conclusions Serum procalcitonin level may serve as guidance for optimization use of antibiotics with AECOPD patients.