血清降钙素原检测指导慢性阻塞性肺疾病急性加重抗生素应用的价值

Detection of serum procalcitonin to guide second-classed AECOPD patients to use actibiotics in clinical application value

目的:探讨血清降钙素原(PCT)指导II级慢性阻塞性肺疾病急性加重(AECOPD)患者抗生素应用的意义。方法:将240例住院AECOPD患者随机分为PCT组和对照组。PCT组在入院1 h内及以第3、5、8天检测血清降钙素原(PCT)水平,若后1次PCT<0.1μg/L时停用抗生素,PCT≥0.1μg/L继续应用。对照组以《慢性阻塞性肺疾病诊治指南》使用抗生素。结果:PCT组和对照组抗生素使用天数分别为(5.6±1.4)和(9.2±2.2)(P<0.01),住院时间(8.2±1.1)vs(11.4±2.5)(P<0.05),平均住院费用(元)(5700±201)对(6 210±220)(P<0.05),平均抗生素费用(元)(1 650±189)vs(2 350±210)(P<0.01),临床有效率、随访1年内住院次数、急性加重次数、出院至下次急性加重时间等无统计学差异。两组1年后FEV1变化数值,无统计学差异(P>0.05)。结论:根据PCT水平的抗生素使用有助于减少Ⅱ级AECOPD患者抗生素应用。

Objective To explore the clinical value of serum procalcitonin （PCT）-based antibiotictherapy in the second-classedexacerbations of chronic obstructive pulmonary disease （AECOPD）. Methods 240patients diagnosised as AECOPD were randomized to the PCT group and the control group. Serum PCT levels ofpatients from the PCT group were measured 1 h after hospitalized and the third, fifth, eighth day respectively.When PCT 〈 0.1 μg/L, patients will stop taking antibiotics and initiated while PCT I〉 0.1 μg/L. Antibiotictreatment in the control group was based on guidelines of COPD diagnosis and treatment. Results Duration ofantibiotic therapy and hospitalization were respectively 5.6 ±1.4 and 8.2 ± 1.1 days in the PCT group, 9.2±2.2 and 11.4 ± 2.5 days in the control group （both P 〈 0.05）. Mean costs of hospitalization expensesandantibiotic therapy were 5700 ± 201 and 1650 ± 189） yuan in the PCT group, 6210 ±220 and 2350 ± 210 yuanin the control group （both P 〈 0.05）. The clinical effective rate, times of exacerbation, one-year AFEV1, the1-year hospitalization rate and time to next exacerbation all showed no significant differences between the twogroups. Conclusion PCT-guided antibiotic treatment reduces antibiotic use inthe second-classed acuteexacerbations patients.