降钙素原治疗儿童重症感染抗生素降阶梯临床价值研究

The investigation of the value of PCT in guiding de-escalation therapy for severe infection in children

目的探讨血清降钙素原(PCT)在儿童重症细菌感染抗生素降阶梯治疗中的指导价值。方法将2012年1月至2013年2月在安徽医科大学附属安庆医院收治的243例患儿,分为重症细菌感染组68例,局部细菌感染组63例,非细菌感染组112例。均在入院后24 h内进行PCT、超敏C反应蛋白(hs-CRP)及外周血白细胞计数(WBC)等检查。根据病情轻重、PCT等检查结果,为患儿选用合理的抗生素治疗。比较3组患儿PCT、hs-CRP、WBC的差异。结果重症细菌感染组PCT、hs-CRP、WBC均升高显著;局部细菌感染组PCT、WBC轻度升高,hsCRP升高显著;非细菌感染组三者升高不明显。重症细菌感染组与局部细菌感染组间PCT、hs-CRP、WBC水平P50(P25,P75)比较差异有统计学意义(P<0.05);重症细菌感染组与非细菌感染组间PCT、hs-CRP、WBC水平P50(P25,P75)比较,差异有统计学意义(P<0.05);局部细菌感染组与非细菌感染组间PCT、hs-CRP水平P50(P25,P75)比较差异有统计学意义(P<0.05),WBC水平差异无统计学意义(P>0.05)。结论 PCT水平可作为早期诊断细菌感染、甄别细菌感染轻重的可靠实验室指标;动态监测PCT水平,可及时评估抗生素疗效,对重症细菌感染合理应用抗生素及降阶梯治疗具有较高的指导价值。

Objective To investigate the value of PCT in guiding de-escalation therapy for severe infection in children.Methods From January 2012 to February 2013,243 child patients were divided into non-bacterial infection group（112 cases）,serious bacterial infection group（68 cases）and local bacterial infection group（63 cases）. All infectious children received PCT,hs-CRP,WBC and related auxiliary examination within 24 hours after admission. Those patients were treated with antibiotics according to related laboratory examination and diagnosis. Results The serum PCT,hs-CRP and WBC in serious bacterial infection group were significantly increased. The serum PCT and WBC in local bacterial infection group were slightly increased and hs-CRP was significantly increased. The serum PCT,hs-CRP and WBC in non-bacterial infection group were insignificantly increased. The difference of PCT,hs-CRP and WBC level between serious bacterial infection group and local bacterial infection group by P50（P25,P75）was of statistical significance（P〈0.05）. The difference of PCT,hs-CRP and WBC level between serious bacterial infection group and non-bacterial infection group by P50（P25,P75）was of statistical significance（P〈0.05）. The difference of PCT and hs-CRP level between local bacterial infection group and non-bacterial infection group by P50（P25,P75）was of statistical significance（P〈0.05）,and the difference of WBC level was of no statistical significance（P〉0.05）. Conclusion The level of PCT can be used as a reliable laboratory standard in diagnosing bacterial infection and reflecting the severity of bacterial infection. Dynamic observation of PTC level can evaluate the efficacy of antibiotics immediately,and bears a relatively high value in proper use of antibiotics and de-escalation therapy for clinician.