炎性指标与降钙素原在抗菌药物治疗心血管内科重症感染疗效评价中的价值

Effect of inflammatory indexes and procalcitonin on treatment of severe infection in cardiology department

目的探讨血清炎性指标与降钙素原(PCT)危急值变化对采用抗菌药物治疗的心血管内科感染重症患者病情发展的影响。方法选取2015年5月-2017年12月于医院住院治疗的心血管内科感染重症患者177例,按照随机数字表法分为对照组88例和研究组89例,对照组给予常规治疗,研究组在对照组的基础上,根据PCT危急值的变化合理运用抗菌药物治疗。分析治疗前后血清C-反应蛋白(CRP),白细胞介素-6-(IL-6)、IL-8,肿瘤坏死因子-α(TNF-α)水平变化;比较两组的治疗效果,抗菌药物使用情况;随访1个月,观察两组患者停药后的复发情况。结果研究组疗效优于对照组(P<0.001);研究组抗菌药物使用时间为(3.02±1.18)d、停药后复发率为0均短(低)于对照组(P<0.05);两组治疗后各血清炎性因子水平均低于治疗前(P<0.05);且研究组治疗后的CRP、TNF-α、IL-6和IL-8分别为(4.16±1.24)pg/ml、(1.14±0.26)pg/ml、(8.25±1.87)pg/ml和(8.16±1.43)pg/ml均低于对照组(P<0.05)。结论临床可根据检测PCT危急值的变化及血清炎性因子水平选择是否停用抗菌药物,并判断感染情况,避免了滥用抗菌药物对患者造成的伤害,疗效理想,且停药后复发率低,具有一定的临床价值。

OBJECTIVE To explore the influence of variations of critical values of serum inflammatory markers and critical value procalcitonin(PCT)on the development of infected patients with severe cardiovascular treated with antibiotics.METHODS A total of 177 patients with severe cardiovascular infections hospitalized from May 2015 to December 2017 were enrolled and divided into control group(88 cases)and research group(89 cases)according to the random number tables.The control group was given routine treatment.The antibiotics were reasonably used in the research group based on the change of the threshold value of PCT.The changes of serum levels of C-reactive protein(CRP),interleukin-6-(IL-6),IL-8 and tumor necrosis factor-alpha(TNF-alpha)were analyzed before and after the treatment.The therapeutic effect and the use of antibiotics were compared between the two groups.The recurrence of the two groups was going to be observed after a month follow-up.RESULTS The curative effect in the study group was significantly better than that in the control group(P<0.001).The duration of antibiotics treatment in the study group was(3.02±1.18)days,and the recurrence rate was 0,which was significantly shorter than that in the control group(P<0.05).The levels of serum inflammatory factors in the two groups after treatment were significantly lower than those before treatment(P<0.05).Levels of CRP,TNF-a,IL-6 and IL-8 in the study group after treatment were(4.16±1.24)pg/ml,(1.14±0.26)pg/ml,(8.25±1.87)pg/ml and(8.16±1.43)pg/ml,respectively,which were significantly lower than that in the control group(P<0.05).CONCLUSIONS The comparison result between detection value and the critical value of PCT and the levels of serum inflammatory factors can help us to decide whether or not we stop antibiotics treatment and to evaluate the infection situation,so as to avoid the side effect caused by abusing antibiotics.The curative effect is ideal,and the recurrence rate is low after drug withdrawl,which shows certain clinical value.