血清降钙素原水平对慢性阻塞性肺疾病急性加重期抗生素使用的指导价值

The value of serum procalcitonin level in guiding the use of antibiotic in patients with acute exacerbation of chronic obstructive pulmonary disease

目的探讨血清降钙素原(PCT)水平对慢性阻塞性肺疾病急性加重期(AECOPD)患者抗生素使用的指导价值。方法把108例AECOPD患者按住院号尾数单双号分为PCT组(n=52)和常规组(n=56)。PCT组在入院第1、4、7和10天检测血降钙素原浓度,依据测定值决定抗菌药物使用与否;常规组根据患者临床表现及抗生素治疗指南使用抗生素。结果两组中、重度患者临床有效率差异无统计学意义,而极重度患者PCT组低于常规组。两组患者抗生素使用率、使用时间、住院天数及医疗费用相比差异具有显著性,随访6个月内再次进入急性加重期概率、急性加重次数及进入下次急性加重的时间均无显著差异。结论血清降钙素原具有指导中度及重度AECOPD患者抗菌治疗的作用,能够减少抗生素的暴露。

Objective To investigate the value of serum procalcitonin （PCT） level in guiding the use of antibiotic in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD）. Methods 108 patients with AECOPD were divided into the PCT group （n=52） and the conventional treatment group （n=56） according to the mantissa of their admission number. Serum PCT levels in patients from the PCT group were measured in day 1, 4, 7 and 10 after hospitalization, and decide whether use antibiotic according to the test result. In conventional treatment group, patients received antibiotics according to the clinical features and treatment guidelines of antibiotics. Results There was no statistical significance in the clinical effective rate of moderate and severe patients between two groups, while the clinical effective rate of extremely severe patients in PCT group was lower significantly than that in conventional treatment group. The differences between two groups in the antibiotic utilization rate, duration of antibiotic therapy, hospitalization and medical expense were significant. The two groups＇ exacerbation times and time to next exacerbation were not significant within 6 months. Conclusion Serum procalcitonin can guide the antibiotic treatment on the moderate and severe patients with AECOPD, and it can reduce the exposure of antibiotics.