血清降钙素原在指导老年社区获得性肺炎患者抗生素治疗中的应用

Application of serum procalcitoninin in elderly patients with community acquired pneumonia

目的：探讨降钙素原在老年社区获得性肺炎（CAP）患者抗生素治疗中的指导意义。方法选取我院2010年1月至2013年12月住院治疗的老年 CAP 患者62例，年龄64.0～87.0岁。应用计算机随机分为两组：常规治疗组33例，依据临床症状及传统的临床应用抗生素标准使用抗生素；降钙素原组29例，抗生素的使用时间由血清降钙素原浓度的变化决定。观察两组抗生素的使用时间、使用费用及患者住院总费用、住院时间、临床预后（包括有效、病情加重以及死亡）情况。结果降钙素原组的抗生素使用时间为（12.2±1.4）d，抗生素使用费用为（3341.9±52.73）元，住院时间为（12.1±1.8）d，住院总费用为（5346.2±1274.5）元，均低于常规治疗组[（16.9±3.5）d、（3816.28±84.27）元、（14.7±2.9）d、（6653.2±1132.8）元]，差异均有统计学意义（ t 值分别为6.77、26.14、4.17、4.28，P 均＜0.001）。两组患者临床预后（包括有效、加重、死亡）情况比较差异均无统计学意义（ P 均＞0.05）。结论检测降钙素原指导老年 CAP 患者的抗生素使用，能够防止抗生素滥用。

Objective To explore the role of procalcitonin（PCT）in antibiotics therapy of elder patients with community acquired pneumonia（CAP）. Methods Sixty-two elderly patients with CAP who hospitalized in Linxi Hospital of Kailuan General Hospital from Jan. 2010 to Dec. 2013 were selected as study subjects,and their age span were 54. 0 - 87. 0 years old. All the patients were randomly divided into conventional therapy group（n= 33）and PCT group（n = 29）. The use of nntibiotics in conventional treatment group was based on clinical symptoms of patients and the standard of antibiotics application in clinic,while in PCT group was based on PCT serum levels. The main observation indexes including days of antibiotics use,cost of antibiotics use,hospital stay, total cost of hospital stay,clinical efficacy,aggravating cases and death cases. Results The days of antibiotics use,cost of antibiotics use,hospital stay,total cost of hospital stay in PCT group were（（12. 2 ± 1. 4）d, （3 341. 9 ± 52. 73）yuan,（12. 1 ± 1. 8）d,（5 346. 2 ± 1 274. 5）yuan）lower than that in conventional therapy group（（16. 9 ± 3. 5）d,（3 816. 28 ± 84. 27）yuan,（14. 7 ± 2. 9）d,（6 653. 2 ± 1 132. 8）yuan）,and the differences were significant（t = 6. 77,26. 14,4. 17,4. 28;P 〈 0. 001）. There were no significant difference in terms of clinical prognosis（ clinical efficacy,aggravating cases and death cases）（ P 〉 0. 05）. Conclusion Procalcitonin can guide antibiotics application in the elderly patients,and then prevent the abuse of antibiotics.