降钙素原对非ST段抬高急性冠脉综合征合并全身炎症反应综合征患者治疗策略的指导作用分析

Guiding Function of Procalcitonin in Treatment Strategy of Non-ST-segment Elevation Acute Coronary Syndrome Complicated by Systemic Inflammatory Response Syndrome

目的对比非ST段抬高急性冠脉综合征(NST-ACS)合并全身炎症反应综合征(SIRS)患者早期介入策略与降钙素原(PCT)指导下介入策略的优劣及抗菌药物使用情况。方法选择2010年6月—2012年8月首都医科大学附属复兴医院行择期经皮冠状动脉介入治疗(PCI)的NST-ACS患者146例为研究对象,采用随机数字表法分为A、B 2组。A组(n=73)行早期(<72 h)PCI治疗并根据传统炎症指标决定是否应用抗菌药物。B组(n=73)根据入院时PCT水平再分为B1(PCT≥2.0μg/L):应用抗菌药物治疗并择期(≥72 h)行PCI;B2(0.5μg/L≤PCT<2.0μg/L):根据传统炎症指标经验性决定PCI时机和抗菌药物的应用;B3(PCT<0.5μg/L):行早期(<72 h)PCI,不应用抗菌药物治疗。对比A、B 2组患者抗菌药物使用情况、平均住院天数及术后30 d不良事件的差异。结果在B组分组中,B1组患者4例,B2组13例(其中7例应用抗菌药物治疗),B3组56例(其中1例因明确泌尿系统感染而应用抗菌药物)。A组较B组抗菌药物使用率和平均住院天数升高,差异均有统计学意义(P<0.05)。术后30d,B组缺血事件、肾功能恶化及总终点事件发生率均低于A组,差异有统计学意义(P<0.05)。结论应用PCT指导NST-ACS合并SIRS患者的治疗策略,可以优化介入时机的选择,促进抗菌药物的合理化应用,减少不良事件的发生。

Objective To compare the early intervention strategy with intervention strategy guided by procalcitonin （PCT） for patients with non - ST - segment elevation acute coronary syndrome （ NST - ACS） combined with systemic inflammato- ry response syndrome （SIRS） and the uses of antibacterial drugs. Methods A total of 146 NST - ACS patients with elective percutaneous coronary intervention （PCI） in Fuxing Hospital from June 2010 to August 2012 were assigned randomly into groups A （n = 73 ）, B （n = 73）. Group A were given early PCI （ 〈 72 h） and antibacterial drug use based on traditional inflammatory markers. Group B were subdivided, based on admission PCT values, groups B1 [ n = 4, PCT ≥ 2.0 μg/L, using antibiotic therapy and selective PCI （1〉72 h）], B2 （0. 5 μg/L≤PCT 〈2. 0 μg/L, intervention timing and use of antibacterial decided on traditional inflammatory markers, n = 13, 7 used antibiotic therapy）, B3 [ PCT 〈 0. 5 μg/L, early PCI （ 〈 72 h ） without antibiotic therapy, n = 56, 1 used antibacterial drugs due to urinary system infection]. Uses of antibacterial, average hospital stays and adverse reactions 30d after operation were compared between groups A, B. Results There was significant difference in antibacterial drug use rate and average hospital stay between 2 groups （ P 〈 0. 05 ）. The incidence of renal function deteriora- tion and cardiac ischemic events was lower in group B than in group A 30 d after operation, the difference was significant （P 〈 0.05 ）. Conclusion PCT - guided treatment tragedy combined with SIRS for NST - ACS patients can optimize the timing of in- tervention to promote rational use of antibacterial to reduce the incidence of adverse events.