血清降钙素原监测对肝硬化患者肺部感染抗菌药物的应用价值

目的：探讨肝硬化患者肺部感染应用血清降钙素原（PCT）监测指导抗菌药物使用的临床意义，为临床诊治提供参考依据。方法肝硬化合并肺部感染患者120例，按随机数字表法分为对照组与观察组，各60例。对照组根据临床表现及病情采用常规抗菌药物治疗，观察组在治疗过程中监测血清PCT，根据PCT改变调整实施抗菌药物方案，对比两组患者治疗有效率、抗菌药物使用时间、抗菌药物费用、住院时间、住院费用、二重感染率、住院病死率、炎性指标等。结果观察组患者治疗有效率81.67%，对照组80.00%，两组比较差异无统计学意义（P〉0.05）；观察组抗菌药物使用时间、抗菌药物费用、住院时间、住院费用、二重感染率均低于对照组，差异有统计学意义（P〈0.05）；两组患者住院病死率差异无统计学意义（P〉0.05）；两组患者治疗后血沉、C-反应蛋白（CRP）、白细胞计数水平均有明显改善（P〈0.05），观察组治疗后血沉、CRP、白细胞计数水平均低于对照组，对比差异有统计学意义（P〈0.05）。结论根据PCT检测结果指导肝硬化肺部感染患者抗感染治疗，可有效减少抗菌药物滥用，缩短治疗时间，降低治疗成本，改善患者预后，值得临床推广应用。

ObjectiveTo explore the clinical significance of detection of serum procalcitonin（PCT）in the cirrhosis patients with pulmonary infections so as to provide guidance for clinical diagnosis and treatment.MethodsA total of 120 cirrhosis patients with pulmonary infections who were treated from Jan 2014 to June 2015 were enrolled in the study and randomly divided into the control group and the observation group,with 60 cases in each group. the control group was given the conventional drug therapy according to the clinical manifestations and illness condition,while the observation group was treated with antibiotics based on the change of the PCT level. the effective rate of treatment,time of use of antibiotics,cost of use of antibiotics,length of hospital stay,cost of treatment,incidence of superinfection,hospital mortality,and inflammatory indicators were observed and compared between the two groups of patients.ResultsThe effective rate of treatment of the observation group was 81.67%,the control group 80.00%,and there was no significant difference between the two groups（P〉0.05）. the time of use of antibiotics,cost of use of antibiotics, length of hospital stay,cost of treatment,incidence of superinfection of the observation group,less than those of the control group,there was significant difference（P〈0.05）. the hospital mortality was no significant difference between the two groups（P〉0.05）. the erythrocyte sedimentation rate（ESR）,C-reactive protein（CRP）and the leucocyte count were significantly improved after the treatment between the two groups（P〈0.05）. the level of ESR、CRP and the leucocyte count of the observation group,lower than those of the control group after the treatment,there was significant difference（P〈0.05）.ConclusionThe anti-infection therapy adjusted based on the results of monitoring of PCT may reduce the abuse of antibiotics, shorten the treatment time,reduce the cost of treatment and improve the prognosis of the cirrhosis patients with pulmonary infection,it is worthy to be promoted in the hospital.