动态降钙素原检测在支气管扩张急性加重期患者诊治中的临床意义

Clinical significance of dynamic monitoring of serum procalcitonin levels in diagnosis and treatment of patients with aeute exacerbations of bronchiectasis

目的通过动态检测支气管扩张急性加重期患者的血清降钙素原(PCT)变化,了解其指导诊治的价值。方法收集2013年5月至2015年10月共60例支气管扩张急性加重期患者,常规行诱导痰细菌培养,并将其随机分为两组:观察组30例,动态检测PCT,血清PCT≥0.25μg/L时使用抗生素,PCT<0.25μg/L则停用抗生素;对照组30例,不检测PCT,根据患者临床症状决定抗生素的使用。比较两组患者的临床疗效、抗生素使用天数、住院时间、30 d内再住院率。观察血清PCT水平与痰培养、APACHEⅡ评分的关系。结果两组患者临床有效率、30 d内再住院率比较,差异未见统计学意义(P>0.05)。两组患者抗生素使用天数和住院天数比较差异有统计学意义(P<0.01)。观察组中痰培养细菌结果阳性者入院后第1天血清PCT水平明显高于培养结果阴性者(P<0.01);相关分析表明患者入院后第1天血清PCT水平与APACHEⅡ评分呈正相关(r=0.536,P<0.05)。结论动态检测降钙素原对支气管扩张急性加重期患者的诊治有一定指导意义。

Objective To investigate the value of dynamic monitoring of serum procalcitonin（ PCT） levels in guiding diagnosis and treatment of patients with acute exacerbation of bronchiectasis. Methods A total of 60 patients with acute exacerbation of bronchiectasis from May 2013 to October 2015 were selected,they were given routine sputum bacterial culture,and divided into two groups： the observation group（ n = 30） in which PCT was detected and antibiotics was used when PCT≥0. 25 μg / L while was stopped when PCT 0. 25 μg / L; the control group（ n = 30） in which PCT was not detected and the decision to use antibiotics based on clinical symptoms. Clinical effect,length of stay,duration of antibiotics use and the rate of readmission within 30 days were compared between the two groups. The relationship between serum PCT levels and sputum culture,APACHEⅡ score were observed. Results There was no significant difference in clinical efficacy or the rate of readmission within 30 days between the two groups（ P〈0. 05）,and the differences were significant between the two groups of patients in length of stay and duration of antibiotics（ P〈0. 01）. In the observation group,the serum PCT levels were significantly higher in patients when they had bacteria infection compared to those without bacteria infection（ P〈0. 01）. The correlation analysis showed that the serum PCT levels were positively correlated with the APACHEⅡscores（ r = 0. 536,P〈0. 05）. Conclusion Dynamic monitoring of serum PCT levels may be used as a guide in diagnosis and treatment of patients with acute exacerbation of bronchiectasis.