连续血清PCT监测指导CAP患者抗生素应用

Continuous serum procalcitonin monitoring to guide the antibiotics application for community acquired pneumonia

目的探讨连续监测血清降钙素原(PCT)指导社区获得性肺炎(CAP)患者抗生素应用临床价值。方法2013年2月至2016年3月四川绵阳市中心医院院收治的CAP患者129例,按治疗先后顺序分为连续PCT监测组62例和对照组67例。PCT组:连续PCT检测,并根据PCT结果决定是否应用抗生素治疗;对照组:根据CAP指南采取相应的治疗方案,两组患者共治疗4周后进行评价。记录两组患者CAP治疗有效率、应用抗生素患者比例、抗生素使用时间及抗生素费用有无差别,并评价血清PCT水平与CAP严重程度有无相关性。结果 PCT组和对照组有效率分别为90.3%(56/62)和86.7%(58/67),差异无统计学意义(χ~2=0.44,P>0.05);PCT组应用抗生素比例、抗生素应用时间及抗生素费用均显著低于对照组,差异有统计学意义(P<0.05);PCT组患者治疗期间PCT水平呈现逐步下降趋势;经Spearson相关检验,血清PCT与CAP严重分级(PSI)存在相关性(r=0.71,P<0.05);PSIⅢ患者血清PCT水平显著高于PSIⅠPSIⅡ患者,差异有统计学意义(P<0.05)。结论连续监测血清PCT可以避免CAP抗生素的不合理应用,且不降低CAP治疗效果。

Objective The aim of this study was to evaluate the continuous serum procalcitonin（PCT）monitoring to guide the antibiotics application for community acquired pneumonia（CAP）. Methods From February 2013 to March 2016,129 patients with CAP were included and divided into continuous PCT monitoring group （n=62） and control group （n=67 ）. PCT group：continuous PCT detection ,and according to the results of PCT to determine whether the application of antibiotic treatment was given. Control group：The treatment procedure was done according to the CAP guideline for appropriate treatment. The clinical efficacy was evaluated after 4 weeks treatment for the two groups.The clinical efficacy ,the proportion of patients with antibiotics ,the use of antibiotics and the cost of antibiotics were recorded for the two groups. The correlation between serum PCT level and the severity of CAP was also evaluated. Results The clinical efficacy were 90.3%（56/62） and 86.7%（58/67） for the PCT and control group,respectively with statistical difference （χ^2=0.44,P=0.51）. The proportion of patients with antibiotics ,the use of antibiotics and the cost of antibiotics in the PCT group was significantly lower than that of control group（P〈0.05）. The level of PCT in PCT group was decreased ,and the serum PCT level was significantly higher in PSI Ⅲ patients than those in PSIⅠ and Ⅱ patients （P〈0.05）. Significant correlation was found between PCT and CAP（PSI）grade rs=0.71（P〈0.05）. Conclusion Continuous monitoring of serum PCT could avoid the irrational use of CAP antibiotics ,and did not reduce the effect of CAP treatment.