降钙素原指导AECOPD抗菌药物使用与停用的临床研究

Clinical Research on Procalcitonin Guidance on the Use and Termination of Antibiotic Treatment in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

目的:通过对照研究探讨血清降钙素原(Procalcitonin,PCT)水平用于判断慢性阻塞性肺疾病急性加重期(Acute exacerbations of chronic obetructive pulmonarydisease,AECOPD)使用和终止抗菌药物治疗时机的可行性。方法:120例AECOPD住院患者随机分为实验组和对照组,每组60例。实验组在入院后24小时内采血进行血清PCT检查,当实验组患者血清PCT>0.5 ng/m L时使用抗菌药物治疗,且PCT>0.5 ng/m L的患者使用抗菌药物后予以隔日采血检查血清PCT水平,如果PCT<0.5 ng/m L或者下降超过峰值的80%时就停止使用抗菌药物;对照组则根据患者的临床症状、体征及医生临床判断决定使用和停用抗菌药物时机。结果:共118例患者完成临床试验。实验组患者的抗菌药物使用天数和住院天数明显低于对照组;实验组患者的住院总费用显著低于对照组(P<0.01);两组AECOPD复发率无差异(P>0.05)。结论:PCT可能是判断AECOPD抗菌药物治疗使用与终止时机的良好指征,此方法不仅可以提高疗效,还可以减少抗菌药物的滥用,降低患者医疗费用减轻经济负担,具有临床可行性。

Objective： To investigate the feasibility of serum procalcitonin （PCT） level in using and ending the timing of antibiotic treatment in acute exacerbation of chronic obstructive pulmonary disease （AECOPD）by randomised controlled trial. Methods： 120 inpatients with AECOPD were randomly divided into experimental group and control group, each group have 60 inpatients. Serum PCT were detected within 24 hours in experimental group, the serum PCT〉0.5 ng/mL of patients in experimental group were given antibiotic treatment. PCT〉0.5 ng/mL of patients in experimental group were carried out serum PCT examination every other day. When level of PCT was less than 0.5 ng/mL or decreased more than 80% of its peak level, antibiotic treatment were advised to stop in experimental group. According to the patient＇s clinical symptoms, signs and clinical judgment of the doctor decided to use and end the timing of antibiotic treatment in control group. Results： 118 inpatients completed the clinical trials. Compared with the control group, the days of using an- tibiotic treatment, hospitalization days in experimental group were significantly lower （P〈0.01）. Compared with the control group, total cost of hospitalization in experimental group was significantly lower （P〈0.01）. Conclusion： PCT level is a good indication to judge the timing of using and ending antibiotic treatment in AECOPD, this method not only can improve the curative effect, but also can reduce the abuse of antibiotics, reduce the economic burden of the patient＇s medical expenses, it has feasibility in clinic.