血清降钙素原在慢性阻塞性肺疾病急性加重期抗感染治疗中的临床意义

The clinical value of serum procalsitonin in anti-infection treatment for acute exacerbation of chronic obstructive pulmonary disease

目的:探讨血清降钙素原(PCT)水平在慢性阻塞性肺疾病急性加重期(AECOPD)抗感染治疗中的临床意义。方法:选取120例AECOPD病人,采用随机数字表法分成PCT组和常规组,各60例。PCT组病人根据血清PCT水平决定抗生素的使用和停用(PCT≥0.25μg/L时使用抗生素,PCT<0.25μg/L不使用或停用抗生素),常规组病人由主治医师根据临床症状和临床经验决定抗生素的使用。主要观察指标为抗生素的使用率、抗生素使用时间、住院时间、临床有效率、二重感染率、半年内复发率、血液炎性指标(白细胞、中性粒细胞、C反应蛋白)以及血气分析指标。结果:PCT组抗生素使用率及二重感染率均低于常规组(P<0.01和P<0.05),抗生素使用时间短于常规组(P<0.01)。PCT组使用抗生素病人、PCT组未使用抗生素病人同常规组比较,住院时间均明显缩短(P<0.01),临床有效率、半年内复发率以及白细胞计数、中性粒细胞、血清C反应蛋白水平和血气分析指标差异均无统计学意义(P>0.05)。结论:根据血清PCT水平指导AECOPD病人抗感染治疗,可以有效减少抗生素使用量,缩短住院时间,降低二重感染率,并且不影响临床治疗效果。

Objective： To explore the clinical value of serum procalsitonin（ PCT） level in anti-infection treatment for acute exacerbation of chronic obstructive pulmonary disease（ AECOPD）. Methods： One hundred and twenty patients with AECOPD were divided into the PCT group and conventional group according to the random number table（ 60 cases each group）. The use of antibiotics in PCT group was adjusted according to the serum level of PCT（ PCT ≥0. 25 μg/L,use antibiotics,and PCT 0. 25 μg/L,not use antibiotics）,and the use of antibiotics in conventional group was adjusted according to the clinical symptoms of patients and clinical experience of doctors. The rate of antibiotics use,length of antibiotics use,length of hospital stay,clinical effective rate,double infection rate,recurrence rate within half a year,inflammatory indicators[including white blood cells（ WBC）,neutrophils,C-reactive protein（ CRP） ]and blood gas index were observed in two groups. Results： The rates of antibiotics use and double infection in PCT group were significantly lower than those in conventional group（ P〈0. 01 and P〈0. 05）,and the length of antibiotics use in PCT group was significantly shorter than that in the conventional group（ P〈0. 01）. Compared with the conventional group,the length of hospital stay in PCT group was significantly shorter（ P〈0. 01）. There were no statistical significances in clinical effective rate and recurrence rate within half a year between two groups（ P〉0. 05）. After treatment,there were no statistical significances in WBC count,neutrophils level,serum CRP level and blood gas index between two groups（ P〉0. 05）. Conclusions： According to the serum PCT level in antiinfection therapy of AECOPD patients,the antibiotics use can be effectively reduced,the length of hospitalization can be shortened,the double infection rate can be decreased,and the therapeutic effect can not be affected.