中性粒细胞 CD64对重症肺炎抗生素疗程的指导价值

Neutrophil CD64 guidance of antibiotic therapy in severe pneumonia

目的：评价中性粒细胞 CD64阳性细胞百分率（CD64％）检测对重症肺炎患者停用抗生素的指导价值。方法入选60例接受抗生素治疗的重症肺炎患者，按随机数字表法分成观察组（n ＝30）和对照组（n ＝30）。观察组根据血清 CD64％停用抗生素，CD64％≤50％时停用抗生素；对照组根据患者临床症状、血白细胞、CRP 决定是否停用抗生素。主要观察指标为抗生素的使用天数、重症监护病房（ICU）住院时间、临床有效率以及病死率。结果观察组抗生素疗程（10．3±5．2）d，对照组抗生素疗程（16．8±5．8）d，两组差异有统计学意义（t ＝－4．570，P ＜0．01）；观察组 ICU 住院时间（6．5±3．5d）d，短于对照组的（10．5±4．5）d，两组差异有统计学意义（t ＝3．843，P ＜0．01）；观察组临床有效率、病死率分别为83．67％、9．68％，对照组分别为82．12％、10．24％，两组差异均无统计学意义（均 P ＞0．05）。结论CD64％指导重症肺炎患者停用抗生素安全、可靠，可有效减少抗生素过度使用，缩短 ICU 住院时间。

Objective To evaluate the value of neutrophil CD64 positive cells percentage（CD64%）detec-tion to stop using antibiotic in patients with severe pneumonia.Methods 60 accepted antibiotic therapy patients with severe pneumonia,in accordance with the random number table,were separated into observation group（n =30）and control group（n =30）.Antibiotics were stopped according to CD64% in observation group,while it according to the clinical symptoms,the plasma level of white blood cell and C -reactive protein in control group.The main observation indexes included the days of antibiotics use,the length of Intensive Care Unit（ICU）stay,clinical efficacy and the case fatality rate.Results The days of antibiotics use in the observation group was （10.3 ±5.2）d,while it was （16.8 ± 5.8）d for patients in the control group,and it had significant difference（t =-4.570,P 〈0.01）.The length of ICU stay in the observation group was shorter than that in the control group[（6.5 ±3.5）d vs （10.5 ±4.5）d],and it had significant difference（t =3.843,P 〈0.01）.The clinical efficacy were 83.67% and 82.12%,and the case fatality rate were 9.68% and 10.24% in the observation group and control group,respectively,and both had no significant difference（P 〉;0.05）.Conclusion Stop using antibiotics according to the neutrophil CD64 % is safe,reliable,and can effectively reduce the excessive use of antibiotics and shorten the length of ICU stay in patients with severe pneumonia.