降钙素原在细菌性肝脓肿诊治中的临床价值

Clinical value of Procalcitonin(PCT)in bacterial liver abscess in the diagnosis and treatment

目的探讨血清降钙素原（procaldtonin，PCT）对细菌性肝脓肿在抗菌药物的合理选择、及时减量、正确降级的指导意义，从而减少临床耐药菌的产生，同时在一定程度上减少患者的住院费用。方法回顾性分析2011年11月-2012年5月在医院确诊的8例细菌性肝脓肿患者的临床资料，动态检测患者WBC、PCT、CRP，采用SPSS13．0进行数据处理。结果纳入研究的8例患者，其中PCT≥10ng／ml3例，2～10ng／ml2例，0．5～2ng／ml1例，〈0．5ng／ml2例，WBC计数〉10×10^9／L5例，CRP〉100mg／L6例；脓汁培养6例，阳性结果5例，均为肺炎克雷伯菌，产ESBLs阴性；血清WBC、PCT、CRP在抗菌药物治疗1周后均呈现下降趋势，尤其以PCT水平下降更明显。结论临床医师可以通过动态检测血清PCT水平，及早对细菌性肝脓肿做出诊断，并合理选择抗菌药物进行治疗。

OBJECTIVE To investigate the guiding significance of the serum procalcitonin （PCT） for bacterial liver abscess in the rational choice of antibiotics, timely reduction, correct degradation, so as to reduce bacteria resist- ance to antimicrobial agentsin clinic as well as hospital costs for patients. METHODS The clinical data of 8 patients with bacterial liver abscess 1 were retrospectively analyzed. Dynamic detection was made on the WBC, PCT and CRP for patients SPSS 13.0 was used for data processing. RESULTS A total of 8 cases of patients were included in the study, among which, there were 3 cases with the PCT equal or more than 10 ng/ml, 2 cases with PCT equal or more than 2 ng/ml but less than 10 ng/ml, 1 case with PCT equal or more than 0.5 ng/ml but less than 2ng/ ml, 2 cases with PCT less than 0.5 ng/ml, 5 cases with the WBC more than 10 ＊ 109/L, 6 cases with CRP more than 100 mg/L. Fester culture was conducted for 6 cases, among which 5 cases were positive, which were Klebsiella pneumonia without extended spectrum beta lactamases（ESBLs）-producing. The WBC, PCT and CRP after one week antibiotic treatment presented a down trend, especially with PCT levels dropping more apparently. CONCLUSION The clinicians should conduct dynamic detection for the serum PCT level so that the diagnosis can he made for bacterial liver abscess as soon as possible and make reasonable selectiort of antibiotics for treatment.