重症感染患儿降钙素原水平变化意义及指导合理用药的临床研究

Effect of procalcitonin on severe infection in children and rational drug use

目的通过比较重症感染患儿治疗前后降钙素原水平的变化,探讨降钙素原在患儿重症感染中诊断的意义及指导临床合理用药的价值。方法选取2011年1月至2013年10月在本院治疗的175例患儿,根据患儿感染情况分为非细菌感染组(70例),重症细菌感染组(55例),局部细菌感染组(50例)。根据治疗方法将重症感染组患儿分为2个亚组,以降钙素原指导用药组(30例)和未按降钙素原指导用药组(25例),分别在入院时和治疗3 d及1周后检测患儿降钙素原、超敏CRP及WBC。偏态计量资料以中位数P50(P25,P75)表示。计数资料采用t检验。3组资料的比较采用Kruskal wallis H检验;2组之间的比较采用SNK-Q、Bonferroni校正等方法;治疗前后比较采用配对t检验,P<0.05为差异有统计学意义。结果 3组之间降钙素原和超敏CRP及WBC的P50(P25,P75)水平,差异有统计学意义(P<0.05)。治疗3 d后当感染明显得到控制并好转时,复查降钙素原和超敏CRP,治疗前后的降钙素原水平变化差异有统计学意义(P<0.05),能较好地反映感染控制情况;以降钙素原指导用药的患儿在住院时间和抗感染费用均较未按降钙素原指导用药的患儿明显偏低,差异有统计学意义(P<0.05)。结论降钙素原在重症感染早期即显著升高,且可反应细菌感染的严重程度。其准确性、特异性均优于超敏CRP及WBC,可作为重症感染的新型诊断指标。利用降钙素原水平指导合理用药,可及时、准确地控制感染,减少患儿住院时间和治疗费用。

Objective To explore the value of procalcitonin in the diagnosis and to guide clinical rational drug use by comparing the level change of procalcitonin before and after the treatment of children with severe infection. Methods A total of 175 children in our hospital from January 2011 to October 2013 were chosen and divided into a control group（70 patients）, a severe bacterial infection group（55 patients）, and a localized bacterial infection group（50 patients） according to the situation of infection. The severe bacterial infection group was divided into 2 subgroups according to different treatments： a directed calcitonin group of 30 patients and a non-directed calcitonin group of 25 patients. The levels of procalcitonin, allergic CRP and WBC were detected at admission and treatment after 3 days and a week respectively. Skewness measurement data were expressed by median P50（P25, P75）. T test was used. Kruskal Wallis H inspection was used to compare the 3 groups of data. SNK-Q and Bonferroni correction methods were used to compare the 2 groups. Matching t test was used to compare before and after the treatment. P 〈0.05 was considered statistically significant. Results The level of P50（P25, P75） of procalcitonin CRP and WBC among the 3 groups were significantly different（P 〈0.05）. The infection was obviously improved after the 3 day treatment, and the levels of calcitonin and allergic CRP were tested. The difference in procalcitonin level change was significant before and after the treatment（P 〈0.05）, which better reflected the infection control situation. The hospitalization days and antiinfectious expenses administered by procalcitonin were lower than without procalcitonin（P 〈0.05）. Conclusion The level of procalcitonin increases in the early stage of severe infection, indicating the severity of bacterial infection. The accuracy and specificity of procalcitonin is superior to allergic CRP and WBC. Procalcitonin can be used as a new diagnosis index of severe infection, which may be used to guide rational drug use timely and control the infection accurately, therefor reducing hospitalization days and cost of treatment.