降钙素原与C反应蛋白水平对老年卒中后肺部感染患者抗生素治疗的临床指导意义

Significance of procalcitonin and C-reactive protein test for directing antibiotic therapy in elderly stroke patients with pulmonary infection

目的探讨降钙素原(PCT)与C反应蛋白(CRP)水平在老年人肺部感染治疗中的指导意义。方法60例卒中后卧床老年肺部感染患者分为常规治疗组、PCT指导治疗组及CRP指导治疗组。常规治疗组按照常规评估感染控制的方法指导抗生素治疗,PCT指导治疗组通过检测血清PCT浓度来指导抗生素使用,CRP指导治疗组通过检测血清CRP浓度来指导抗生素使用。比较3组抗生素使用时间、使用率、抗生素治疗结束后3组患者炎性指标(白细胞、中性粒细胞)、血气分析[动脉血氧分压(PaO2)、氧合指数(PaO2/FiO2)]、临床肺部感染积分(CPIS)以及抗生素花费之间的差异。结果 3组经治疗后,(1)患者白细胞、中性粒细胞:PCT组[(8±4)×109/L、0.62±0.04]、CRP组[(8±3)×109/L、0.67±0.02]、常规组[(7±4)×109/L、0.65±0.04]差异无统计学意义(均P>0.05);(2)PCT组CPIS(4.0±1.4)分明显低于常规治疗组(7.7±1.0)分和CRP组(6.9±1.6)分,差异有统计学意义(P<0.05)。(3)治疗后血气分析:PCT组[PaO2(72±7)mmHg,氧合指数(302±48)];CRP组[PaO2(76±6)mmHg,氧合指数(336±47)];常规组[PaO2(76±5)mmHg,氧合指数(328±46)];差异无统计学意义(均P>0.05)。3组在治疗前后,炎性指标中除白细胞计数外,中性粒细胞及CPIS均较治疗前明显降低;血气分析较治疗前明显改善;PCT组PCT值也较治疗前降低[(1.7±0.8)mg/L至(0.5±0.8)mg/L]。同时,在抗生素使用时间上,常规组(9.5±2.4)d与PCT组(5.9±1.6)d相比,差异有统计学意义(t=11.96,P<0.01);常规组与CRP组(9.3±2.1)d比较差异无统计学意义(t=0.56,P>0.05);PCT组与CRP组差异有统计学意义(t=12.8,P<0.01)。抗生素使用率分别为常规组100%、CRP组95%和PCT组70%,常规组、CRP组与PCT组比较,差异有统计学意义(χ2=12.41,11.88,P<0.01),常规组与CRP组比较,差异无统计学意义(χ2=0.43,P>0.05)PCT组抗生素使用率及抗生素花费明显低于常规组和CRP组。结论在卒中后老年肺部感染患者治疗中,PCT水平是比传统经验评估及CRP水平评估患者感染控制与否的更为准确的指标,可以在达到更好治疗效果的同时减少抗生素的使用,对于减少耐药细菌产生具有重要意义。

Objective To explore the significance of the plasma procalcitonin （PCT ） and C-reactive protein （CRP） level for directing antibiotic therapy in elderly stroke patients with pulmonary infection .Methods Sixty elderly stroke patients with pulmonary infection were randomly separated into the regular therapy group ,the CRP-directed therapy group and the PCT-directed therapy group .The regular therapy group was given regular antibiotic therapy ,while the antibiotic therapy was decided according to the plasma level of PCT or CRP in the PCT-directed therapy group or the CRP-directed therapy group .The time using antibiotics ,cost and utilization rate of antibiot-ics ,as well as inflammatory indicators including white blood cells ,neutrophils ,blood gas analysis and clinical pul-monary infection score（CPIS）were compared among the three groups .Results After treatment ,there were no sig-nificant differences in white blood cells ,neutrophils and blood gas analysis among the three groups .But the CPIS was markedly lower in PCT-directed therapy group than that in regular therapy group and CRP-directed therapy group .The neutrophils ,CRP ,PCT and CPIS were significantly improved after treatment than before in the both groups .Meanwhile ,the time using antibiotics was longer in regular treatment group and in the CRP-directed ther-apy group .The utilization rate of antibiotics was higher in regular treatment group and the CRP-directed therapy group .Conclusion Using PCT levels for directing treatment in elderly stroke patients with pulmonary infection can achieve better curative effect and reduce the use of antibiotics .