降钙素原指导社区获得性肺炎抗菌治疗终止的应用研究

Research on procalcitonin-guided antibiotic treatment termination in community-acquired pneumonia

目的通过对照研究利用血清降钙素原(Procalcitonin,PCT)水平判断社区获得性肺炎(community-acquired pneumonia,CAP)终止抗菌药物治疗的时机的可行性。方法 220例CAP住院患者随机分为两组:实验组140例,对照组80例。实验组在入院后24 h内采集静脉血清进行PCT检查,血清PCT>0.5 ng/ml者隔日进行采血检查,当PCT<0.5 ng/ml或者下降超过峰值的80%时停用抗菌药物;对照组则根据医生临床判断决定停用抗菌药物时机。结果共207例患者完成临床试验。实验组抗菌药物使用天数、住院天数明显低于对照组(6.7±1.3、7.2±1.4 vs 8.6±1.7、9.1±1.6),(P<0.05);实验组住院总费用明显低于对照组(4531±708.3 vs 6067±912.7),(P<0.05);两组肺炎复发率无差异(P>0.05)。结论 PCT是判断CAP抗菌治疗终止时机的良好指征,此方法具有临床可行性。

Objective To investigate the feasibility of serum procalcitonin（ PCT） levels determining the timing of antibiotic therapy termination in patients with community-acquired pneumonia（ CAP） by randomised controlled trial. Methods 220 inpatients with pneumonia were randomly divided into two groups： 140 patients in the experimental group and 80 patients in the control group. In the experimental group,serum PCT was detected within24 hours. If their serum PCT 0. 5ng /ml they were checked every other day for blood later. Antibiotic treatment were adviced to stop in case PCT decreased more than 80% of its peak level or decreased below a value of 0. 5 ng /ml. In the control group,antibiotics termination was according to clinical judgment of the doctors＇ decision. Results 207patients completed the clinical trials. The days of antibiotics and duration of hospitali stay in the experimental group were significantly lower in the experimental group than in the control grou p（ 6. 7 ± 1. 3,7. 2 ± 1. 4 vs 8. 6 ± 1. 7,9. 1± 1. 6）（ P 0. 05）. The total cost of hospital stay in the experimental group was significantly lower than that in the control group（ 4531 ± 708. 3 vs 6067 ± 912. 7）（ P 0. 05）. There was no significant difference in relapse rate of pneumonia between the two groups（ P 0. 05）. Conclusion PCT is a good indication to judge the timing of termination antibiotic therapy in CAP.