降钙素原测定老年肿瘤化疗后粒细胞减少发生HAP患者抗菌药物使用的临床价值

Clinical value of determination of procalcitonin in guiding use of antibiotics for HAP in elderly cancer patients with neutropenia after chemotherapy

目的探讨老年肿瘤化疗后粒细胞减少医院获得性肺炎(HAP)患者中用降钙素原(PCT)值指导抗菌药物使用的临床价值。方法对42例收住ICU的老年肿瘤化疗后粒细胞减少发生HAP患者分为常规治疗组和PCT治疗组;常规治疗组按常规治疗方法使用抗菌药物,PCT治疗组通过检测血清PCT值指导抗菌药物使用,比较两组抗菌药物使用时间、使用率、抗菌药物治疗结束后炎性指标及临床疗效。结果两组经治疗后,PCT治疗组患者的白细胞、中性粒细胞、C反应蛋白(CRP)与常规治疗组差异无统计学意义,PCT治疗组CPIS评分为(4.1±1.2)分,明显低于常规治疗组的(4.6±1.76)分,差异有统计学意义(t=2.16,P<0.05);两组治疗前后,各炎性指标中除白细胞计数外,中性粒细胞、CRP、CPIS评分及PCT均较治疗前明显降低(P<0.05);PCT治疗组抗菌药物使用时间为(11±4)d,抗菌药物使用率为55.0%,显著低于常规治疗组(P<0.01);两组患者ICU住院天数、机械通气时间比较,常规治疗组明显延长(均P<0.01)。结论老年肿瘤化疗后粒细胞减少发生HAP患者中参考PCT值指导抗菌药物使用,可以达到更好的临床疗效。

OBJECTIVE To explore the clinical value of procalcitonin（PCT） in guiding the use of antibiotics for hospital-acquired pneumonia in elderly cancer patients with neutropenia after chemotherapy.METHODS We selected 42 HAP cancer patients with neutropenia after chemotherapy,they were randomly divided into two groups（A and B）.Group A was regular antibiotic therapy group.Group B was PCT-directed therapy group.The clinical outcomes between the two groups were evaluated with the duration of using antibiotics,utilization rate of antibiotics,inflammatory indicators.RESULTS There was no statistical difference between group A and group B concerning WBC,neutrophils,and CRP,the CPIS in group B was（4.1±1.2） points,significantly lower than（4.6±1.76） points in group A,with statistical difference（t=2.16,P〈0.05）;all of the inflammatory indicators except WBC,neutrophils,CRP,CPIS,and PCT were significantly dec eased as compared with those before the treatment（P〈0.05）,the duration of using antibiotics and the utilization rate were significantly lower in group B [（11±4）d,and 55.0%] than in group A（P〈0.01）;the hospital stay in ICU and the duration of mechanical ventilation of group were significantly prolonged（all P〈0.01）.CONCLUSION To reasonably use antibiotics by referring the PCT value can achieve better clinical efficacy in the treatment of HAP in elderly cancer patients with neutropenia after chemotherapy.