降钙素原在慢性阻塞性肺疾病急性加重期抗感染治疗的应用价值

Study of serum procalcitonin to guide COPD with acute exacerbationpatients to use actibiotics in clinical application value

目的探讨血清降钙素原（PCT）在慢性阻塞性肺疾病急性加重期（AECOPD）抗生素治疗中的应用价值。方法选择120例AECOPD老年患者，随机分成3组，分别为PCT组（43例）、C反应蛋白（CRP）组（39例）和标准组（38例）。PCT组选择PCT〉0．25μg／L时使用抗生素治疗，PCT〉0．25μg／L停用抗生素；CRP组选择CRP〉20mg／L使用抗生素治疗，当复查CRP〈20μg／L停用抗生素；标准组由主治医师根据临床症状决定抗生素的使用及停用。主要研究3组患者临床有效率、抗生素治疗时间、抗生素使用率、住院时间、二重感染率等；同时对比PCT与CRP关系。结果PCT组、CRP组、标准组患者临床治疗有效率分别为90．7％、87．2％、92．1％，3组比较差异无统计学意义（X2＝：0．555，P〉0．05）。PCT组患者抗生素使用率48．8％，CRP组抗生素使用率为59．0％，2组均比标准治疗组89．5％明显降低（X2＝15．565，P〈0．05）。PCT组抗生素平均使用天数为（5．9±1．9）d，CRP组为（6．2±2．1）d，均比标准组[（9．0±2．6）d]短（F：16．081，P〈0．05）。住院天数PCT组为（8．6±2．1）d，CRP组为（8．9±2．1）d，均比标re-N疗组患者[（11．6±3．0）d]短（F＝18．759，P〈0．05）。3组的二重感染的发生率（2．3％VS5．1％VS10．5％，X2＝2．522，P〉0．05）差异无统计学意义。PCT组与CRP组2组在抗生素有效率、抗生素使用率、抗生素使用时间、住院时间等比较差异无统计学意义。同时，血PCT升高，血CRP也随着升高。结论联合检测PCT与CRP可能提高检验的准确性，更好判断AECOPD合并细菌感染指征，‘减少抗生素使用时间及费用，减少住院时间。

Objective Study of serum procalcitonin （PCT） to guide chronic obstructive pulmonary disease with acute exacerbation （AECOPD） patients to use actibiotics in clinical application value. Methods Totally 120 patients with AECOPD were randomly divided into PCT group （ n =43）, CRP group （ n = 39） and standard therapy group （ n =38）. For patients in PCT group, the use of antibiotics was based on PCT serum levels. Antibiotics were stopped when PCT〈0.25 μg/L. Antibiotics were stopped when CRP group〈20μg/L, while in standard therapy group, the use of antibiotics was based on clinical symptoms of patients. The main observation indexes included ratio of antibiotic usage, time of antibiotics use, hospital stay, clinical efficacy, aggravating cases and death cases. Results There were no significant difference in clinical efficacy among the three groups （90.7% vs 87.2% vs 92.1%, all X2 =0.555, P 〈0.05）. However,the ratio of antibiotics usage in PCT and CRP patients was significantly lower than standard therapy group （48.8% vs 89.5%;59.0% vs 89.5%,all X2=15.565, P 〈0.05）.Duration of antibiotic therapy and hospitalization were respectively 5.9 ± 1.9 and 8.6 ± 2.1 days in the PCT group, （6.2± 2.1）and （8.95=2.1） days in the CRP group, （9.05=2.6） and （11.65=3.0） days in the standard group （antibiotic therapy： F = 16. 081, P ± 0.05 ; hospitalization： F = 18. 759, P 〈 0.05）. There were no difference in double infection incidence （2.3 %vs 5.1 %vs 10.5 %, X2= 2. 522, P 〈0.05）. The efficiency of antibiotics, duration of antibiotic therapy, hospitalization time were no significant difference between PCT group and CRP group. When serum PCT increased, serum CRP were increasing. Conclusions The PCT combined CRP may improve the inspection accuracy and the judgment of AECOPD complicated with bacterial infection indications. Also, they may reduce the antibiotics therapy time, antibiotics therapy cost and hospitalization time.