降钙素原指导卒中相关性肺炎抗菌药物应用的meta分析

Meta-analysis of procalcitonin-guided antibiotics therapy in patients with stroke associated pneumonia

目的:系统评价降钙素原(PCT)指导卒中相关性肺炎(SAP)的抗菌药物应用。方法:应用Meta分析方法,对检索并入选的13篇随机对照试验(RCT)进行综合分析。结果:共纳入1 299例患者,Meta分析结果显示:与传统以抗菌药物治疗指南组相比,PCT组能够缩短抗菌药物使用疗程[MD=-3.15,95%CI(-3.68,-2.63),P<0.000 01],缩短住院时间[MD=-2.91,95%CI(-4.67,-1.15),P<0.000 01],而临床有效率[OR=1.44,95%CI(0.91,2.29),P=0.12]及病死率[OR=0.80,95%CI(0.53,1.20),P=0.28]无显著差异。结论:PCT指导卒中相关性肺炎的抗菌药物治疗,能缩短抗菌药物使用疗程及住院时间,且安全、有效、可行。

Objective： To systematically evaluate the effectiveness and safety of procalcitonin（PCT）-guided therapy in comparison with standard stroke guidelines in patients with suspected or confirmed Stroke associated pneumonia（SAP）. Methods： Thirteen randomized controlled trials（1299 patients） were included for statistical analysis using Cochrane Rev Man 5.1 software. Results： PCT-guided therapy was associated with a significant reduction in duration of antibiotics [MD=-3.15, 95% CI（-3.68,-2.63）, P0.000 01] and length of hospital stay [MD =-2.91, 95% CI（-4.67,-1.15）, P 0.000 01], but the clinical efficiency [OR =1.44, 95% CI（0.91, 2.29）, P =0.12] and the mortality [OR =0.80, 95% CI（0.53, 1.20）, P =0.28] were not significantly different. Conclusion： The implementation of a procalcitonin-based algorithm may reduce antibiotic exposure and length of antibiotics in patients with stroke associated pneumonia.