基于降钙素原水平的抗菌药物治疗慢性阻塞性肺疾病急性加重临床价值的系统评价

Procalcitonin guided antibiotics therapy in patients with acute exacerbation chronic obstructive pulmonary disease:a systematic review and Meta-analysis

目的探索基于降钙素原(PCT)水平应用抗菌药物治疗慢性阻塞性肺疾病急性加重(AECOPD)的临床价值。方法计算机检索PubMed、Embase、The Cochrane Library数据库。由2名评价员根据纳入与排除标准独立进行文献筛选、资料提取和质量评价,数据采用RevMan 5.3进行Meta分析。结果共纳入21个随机对照研究,合计2784例患者。分析结果显示:与常规经验治疗相比,基于PCT水平应用抗菌药物治疗AECOPD的患者抗菌药物使用率(RR=0.68,95%CI:0.61~0.76,P<0.05)、抗菌药物使用疗程(MD=-3.02,95%CI:-3.81^-2.22,P<0.05)和住院时间(MD=-2.25,95%CI:-3.35^-1.15,P<0.05)减少,差异有统计学意义;临床有效率、再入院率、再次急性加重率、死亡率和重症监护病房入住率等方面,差异均无统计学意义(均P>0.05)。结论与常规经验治疗相比,基于PCT水平应用抗菌药物治疗慢性阻塞性肺疾病急性加重可以明显减少抗菌药物使用和缩短抗菌药物疗程,安全性、有效性相当。

Objective To explore the effect of procalcitonin guided antibiotic therapy in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),and to provide evidence for clinical practice.Methods PubMed,Embase,The Cochrane Library database were searched.The data was screened,extracted,and reviewed by two researchers independently according to the inclusion and exclusion criteria.The meta-analysis was used RevMan 5.3 software.Results A total of 21 randomized controlled trial(RCTs)involving 2784 patients were included.Compared with standard treatment group,the antibiotic prescription rate(RR=0.68,95%CI:0.61~0.76,P<0.05),the time of antibiotic using(MD=-3.02,95%CI:-3.81 to-2.22,P<0.05),and length of stay(MD=-2.25,95%CI:-3.35 to-1.15,P<0.05)in patients with AECOPD were significantly reduced.There was no significant difference in clinical effective rate,re-admission rate,acute exacerbation rate,mortality,andICU occupancy rate.Conclusion Compared with the conventional experience treatment,the application of antibiotics based on PCT level in the treatment of acute exacerbation of chronic obstructive pulmonary disease can significantly reduce the use of antibiotics and shorten the course of antimicrobial treatment,with the same safety and effectiveness.