降钙素原对指导慢性阻塞性肺疾病急性加重期抗菌治疗的价值

Instruction value of procalcitonin in antibiotic therapy for chronic obstructive pulmonary diseases in acute exacerbation period

目的观察降钙素原(PCT)对慢性阻塞性肺疾病急性加重期(AECOPD)指导抗菌治疗的应用价值。方法选择2011年10月～2013年2月我院收治的符合AECOPD诊断并于住院当日检测血清PCT>0.25μg/L患者87例,随机分为PCT组53例和常规治疗组34例。PCT组根据血清PCT水平指导抗菌治疗,PCT<0.25μg/L停用抗生素;常规治疗组根据患者临床表现、C反应蛋白、白细胞计数决定抗生素的应用。两组同时进行痰细菌学的检查。观察指标为抗菌治疗天数、住院天数、临床有效率、加重或死亡病例数等。结果 PCT组的抗菌治疗天数多在3～10 d;而常规治疗组大多超过14 d,有显著统计学差异(P<0.05);两组患者住院天数比较有统计学意义(P<0.05);二重感染发生病例数两组比较有统计学差异(P<0.05);两组临床有效率、加重或死亡率差异无统计学意义(P>0.05)。结论监测PCT水平对诊治AECOPD可获得更好的疗效,减少不必要的抗生素使用,降低二重感染机会。

Objective To observe the instruction value of procalcitonin（PCT） in antibiotic therapy for chronic obstruc- tive pulmonary diseases in acute exacerbation period（AECOPD）. Methods Selected 87 cases of patients diagnosed with AECOPD and the levels of serum PCT〉0.25 μg/L on the hospitalized day in our hospital from October 2011 to Febru ary 2013,they were randomly divided into the PCT group（53 cases） and routine treatment group （34 cases）.The PCT group received antibiotic therapy according to the level of serum PCT,if the serum PCT level〈0.25 μg/L, stopped using antibiotics; the routine treatment group received antibiotic therapy according to clinical manifestation, C-reactive pro- tein,and white blood cell count.Made the sputum bacteriology examination of the two groups at the same time. Ob- served the antimicrobial treatment days,hospitalization days, clinical effective rate, aggravating or death cases, etc. Re- stilts The antimicrobial treatment days of PCT group were between 3 to 10 days in majority;while the antimicrobial treatment days of routine treatment group were more than 14 days in majority,the difference was statistical significant（P 〈 0.05）; there was significant difference between the two groups in the number of double infection （P 〈 0.05）;and there were no significant differences between the two groups in clinical effective rate, aggravating or death rates （P 〉 0.05）. Conclusion Monitoring the level of PCT can obtain a better curative effect in the treatment of AECOPD,reduce unnecessary antibiotic use,and reduce double infection.