连续监测血清降钙素原对社区获得性肺炎治疗效果的相关性观察

The observation of correlation between continuous monitoring of serum procalcitonin and the treatment effect of community-acquired pneumonia

目的探讨连续监测血清降钙素原(procalcitonin,PCT)对社区获得性肺炎(community acquired pneumonia,CAP)治疗效果的相关性。方法选取我院呼吸科2017年4月~2018年3月收治的100例CAP患者作为研究对象,采用随机数字表分为对照组和试验组,各50例。对照组患者根据CAP诊疗指南给予常规治疗,试验组患者连续检测血清PCT水平,根据检测结果调整抗生素的治疗方案。比较两组患者的临床疗效、抗生素使用人数比例、抗生素使用时间及抗生素治疗费用,并评价PCT浓度与CAP严重程度的相关性。结果试验组的治疗有效率略高于对照组,差异无统计学意义(χ~2=0.44,P>0.05)。试验组抗生素使用人数比例、抗生素使用时间以及抗生素治疗费用均显著低于对照组,差异具有统计学意义(χ~2/t=6.74,8.03,11.17,P<0.01)。试验组PSIⅡ~Ⅳ级患者连续监测的血清PCT浓度均呈逐渐下降趋势,且PSIⅣ级患者初次使用抗生素后PCT浓度下降最显著。PSIⅣ级患者血清PCT浓度显著高于PSIⅡ级及PSIⅢ级患者,差异具有统计学意义(t_1=7.65,t_2=8.33,P<0.05),且PSIⅢ级患者血清PCT浓度也明显高于PSIⅡ级患者,差异具有统计学意义(t_3=5.27,P<0.05)。经Spearson相关检验,血清PCT浓度与CAP严重程度呈正相关(r=0.73,P<0.05)。结论连续监测血清降钙素原指导社区获得性肺炎治疗能够在不降低疗效的前提下避免抗生素的过度使用、降低治疗经济成本,值得临床推广使用。

Objective To explore correlation between continuous monitoring of serum procalcitonin and the treatment effect of community-acquired pneumonia. Methods One hurdred cases of CAP patients received from April 2017 to March 2018 were selected as the study subjects,they were divided into two groups：control group and experimental group based on the random number table,50 cases respectively.Patients in the control group were given routine treatment according to the guidelines for CAP treatment,and the patients in the experimental group were given continuous monitoring of serum procalcitonin and the treatment regimen were adjusted according to the test results.It was compared that the clinical efficacy of the two groups,the proportion of antibiotic use,the time of antibiotic use and the cost of antibiotic treatment,and the correlation between the concentration of PCT and the severity of CAP was evaluated. Results The treatment efficiency of the experimental group was slightly higher than that of the control group,and the difference was not statistically significant（χ~2=0.44,P〈0.05）.The proportion of antibiotics used in the experimental group,the time of antibiotic use and the cost of antibiotics were significantly lower than those in the control group,and the difference was statistically significant（χ~2/t =6.74,8.03,11.17,P〈0.01）.Serum PCT concentration of PSI Ⅱ ~ Ⅳ level patients showed a trend of gradual decline.And after first time use of antibiotics,the PCT concentration of PSI Ⅳ level patients decreased more significantly.Serum PCT concentration of PSI Ⅳ level patients was significantly higher than those of PSI Ⅱ and PSI Ⅱ I level patients（t_1=7.65,t_2=8.33,P〈0.05）,Serum PCT concentration of PSI Ⅱ I level patients was also significantly higher than that of PSI Ⅱ level patients,differences were statistically significant（t_3=5.27,P〈0.05）.The serum PCT concentration was positively correlated with the severity of CAP through Spearson inspection（r=0.73,P〈0.05）. Conclusion It can avoid the overuse of antibiotics and reduce the treatment cost without the precondition of reducing curative effect that continuous monitoring of serum procalcitonin to guide the treatment of community-acquired pneumonia.It＇s worthy of clinical promotion.