血清降钙素原水平对老年心衰合并肺部感染抗生素治疗的指导价值及对血清WBC、CRP和ESR水平的影响

The Significance of Serum Procalcitonin Level in the Treatment of Senile Heart Failure Complicated with Pulmonary Infection and Its Influence on Serum WBC,CRP and ESR

目的探讨血清降钙素原(procalcitonin,PCT)动态变化在老年心衰合并肺部感染患者治疗中的临床应用价值。方法老年心衰合并肺部感染患者共132例,随机分为对照组和实验组各66例。所有患者均给予常规的治疗措施,对照组由主管医师通过分析患者临床症状和病情变化决定使用抗菌药物的治疗时机。实验组于入院后第1、第3、第7和第14天检测血清PCT水平,据PCT水平及其动态变化来决定抗菌药物使用。观察两组患者的抗菌药物疗程、抗菌药物费用、住院时间、住院总费用、二重感染率、临床有效率、住院病死率、半年随访期间肺部感染的发生情况以及停用抗生素时两组患者血清白细胞计数(white blood cell,WBC)、C反应蛋白(C-reactive protein,CRP)和血红细胞沉降率(erythrocyte sedimentation rate,ESR)的差异。结果对照组总有效率81.8%,病死率6.1%,实验组总有效率87.9%,病死率4.5%,二组差异无统计学意义(P>0.05)。实验组在住院时间、住院费用、抗生素使用疗程、抗生素费用和二重感染发生率方面均显著低于对照组(P均<0.05)。停用抗生素时两组患者WBC、CRP和ESR差异无统计学意义(P均>0.05)。结论血清PCT水平可作为老年心衰合并肺部感染治疗中决定是否使用抗生素、评价抗菌药物疗效及作为停用抗生素的参考指标。

Objective To investigate the clinical value of serum procalcitonin （PCT）in the treatment of senile heart failure with pulmonary infection. Methods A total of 132 elderly patients with heart failure and pulmonary infection were randomly divided into control group （n=66)and experimental group （n =66）. Based on routine treatment ,control group were treated with antibiotic according to the clinical symptoms judged by physician. Serum PCT at lst, 3rd,7th and 14th day after admission in the experimental group was evaluated, using antibiotic base the dynamic change of PCT. Antimicrobial medication, cost of antimicrobial drugs, length of hospital stay, total cost of hospitalization, double infection rate, clinical response rate, inhospital mortality, and incidence of pulmonary infection during six months of follow-up were observed. The differences in serum leukocyte count (WBC）, C-reactive protein (CRP）, and erythrocyte sedimentation rate （ESR） between the two groups with antibiotics discontinued were compared. Results In the control group, the total effective rate was 81.8% ,the case fatality rate was 6.1% ,the total effective rate was 87.9% and the case fatality rate was 4.5% in the experimental group, with no significant difference between the two groups (P 〉 0.05). The experimental group was significantly lower than the control group in hospital stay, hospitalization expenses, antibiotic treatment, antibiotic costs and the incidence of double infection（P 〈 0.05). There was no significant difference in WBC, CRP and ESR between the two groups when antibiotics treatment was done (P 〉 0.05). Conclusion Serum PCT concentration can be used as biomarker during heart failure with pulmonary infection treatment, which is a reference index to decide the timing of using antibiotics.