降钙素原在指导特发性肺间质纤维化急性加重患者抗感染治疗中的价值

The value of procalcitonin in guiding patients with acute exacerbation of idiopathic pulmonary interstitial fibrosis for anti-infective treatment

目的探讨降钙素原(PCT)在指导特发性肺间质纤维化(IPF)急性加重患者抗感染治疗中的价值。方法选取2014年5月至2017年10月在郑州大学第一附属医院接受治疗的200例IPF急性加重患者,按照入院顺序分为PCT组(110例)和常规治疗组(90例)。PCT组根据PCT水平应用或停用抗生素,PCT≥0.25 ng/mL时停用抗生素,PCT<0.25 ng/mL时应用抗生素。常规治疗组按照抗生素使用指南应用或停用抗生素。观察两组抗生素使用率、抗生素费用、抗生素应用时长、机械通气使用率、住院时间、死亡率、治疗有效率以及治疗1周后白细胞介素-17(IL-17)、白细胞介素-6(IL-6)水平。结果 PCT组抗生素使用率、抗生素费用、机械通气使用率低于常规治疗组,抗生素应用时长、住院时间短于常规治疗组,治疗有效率高于常规治疗组,差异有统计学意义(P<0.05)。两组死亡率比较,差异无统计学意义(P>0.05)。治疗1周后,PCT组IL-17、IL-6水平低于常规治疗组,差异有统计学意义(P<0.05)。结论 IPF急性加重患者根据PCT水平进行抗感染治疗,可缩短抗生素应用时长、住院时间,减少抗生素使用,避免抗生素滥用,快速控制炎症水平。

Objective To explore the value of procalcitonin(PCT)in guiding patients with acute exacerbation of idiopathic pulmonary interstitial fibrosis(IPF)for anti-infective treatment.Methods Two hundred patients with acute exacerbation of IPF who accepted treatment in the First Affliated Hospital of Zhengzhou University from May of 2014 to October of 2017 were selected.The patients were divided into PCT group(110 cases)and routine treatment group(90 cases)according to the order of admission.PCT group applied or discontinued antibiotics based on PCT levels.When PCT level was equal or greater than 0.25 ng/mL,patients discontinued antibiotics.When PCT level was less than 0.25 ng/mL,patients applied antibiotics.Routine treatment group applied or discontinued antibiotics according to antibiotic use guidelines.The antibiotic use rate,antibiotic cost,antibiotic application time,mechanical ventilation rate,hospital stay,mortality rate,effective rate of treatment and the levels of interleukin-17(IL-17),interleukin-6(IL-6)after one week of treatment of two groups were observed.Results The antibiotic use rate,antibiotic cost,mechanical ventilation rate of PCT group were lower than those of routine treatment group,and the antibiotic application time and hospital stay of PCT group were shorter than those of routine treatment group,and the effective rate of treatment of PCT group was higher than that of routine treatment group,and the differences were statistically significant(P<0.05).There was no significant difference in mortality between two groups(P >0.05).The levels of IL-17 and IL-6 of PCT group were lower than those of routine treatment group after one week of treatment,and the differences were statistically significant(P<0.05).Conclusion The patients with acute exacerbation of IPF get anti-infective treatment according to PCT level.The antibiotic application time and hospital stay can be shortened,and the antibiotic use can be reduced,and the antibiotic abuse can be avoided.The inflammation level can be controlled quickly.