降钙素原在老年人群抗感染治疗中指导作用的荟萃分析

Meta-analysis of the effect of procalcitonin on anti-infection treatment in the elderly

目的探讨降钙素原(PCT)指导抗感染治疗对老年患者预后的影响。方法通过检索PubMed、EMBASE数据库、Cochrane图书馆、Cochrane临床试验中心注册库及中文SinoMed数据库, 查找PCT指导抗感染治疗对老年患者预后影响的随机对照临床研究, 按照PRISMA声明进行, 主要研究目的为评估抗生素应用时间。结果本研究检索后最终纳入9项随机对照临床研究(RCT), 共涉及2 702例老年患者, 平均随访3.5个月(1~12个月), 平均年龄(71.3±8.9)岁, 男性占52.8%, 基础白细胞(WBC)为12.9×109/L, C反应蛋白(CRP)为18.9 mg/L, PCT为0.38 μg/L。与应用常规抗感染治疗相比, PCT指导抗感染治疗能够降低老年患者的抗生素应用时间[标化均方差(SMD):-2.39 d, 95%CI:-4.03~-0.75 d, P=0.004], 但PCT指导抗感染治疗对住院时间(SMD:-0.46 d, 95%CI:-1.05~0.14 d, P=0.135)、再感染率[相对危险度(RR)=0.87, 95%CI:0.73~1.03, P=0.105]和全因死亡风险(RR=1.02, 95%CI:0.80~1.31, P=0.863)均无显著影响。结论 PCT指导抗感染治疗能减少老年患者的抗生素应用时间, 但其他临床效果仍需要更多大型研究验证。

Objective To evaluate the effect of procalcitonin(PCT)guiding anti-infection therapy on the prognosis of elderly patients.Methods By searching PubMed,EMBASE database,Cochrane library,Cochrane clinical trial center registry and SinoMed database in Chinese,we searched for a randomized controlled clinical(RCT)study on the effect of PCT-guided anti-infection treatment on the prognosis of elderly patients,which was conducted according to the PRISMA statement.The main purpose of the study was to evaluate the time of antibiotic application.R.esultsAfterretrieval,9 RCT clinical studies were finally included,involving 2702 elderly patients,with an average follow-up of 3.5 months(1-12 months).The average age was(71.3±8.9)years old,with 52.8% of males and baseline levels of white blood cell(WBC)was 12.9×10^(9)/L,C-reactive protein(CRP)was 18.9 mg/L,PCT was O.38μg/L.Compared with conventional anti-infective therapy,PCT-guided anti-infective therapy can reduce the antibiotic application time of elderly patients[standard mean difference(SMD)=-2.39 days,95%CI(-4.03,-0.75)days,P=0.004].However,PCT-guided anti-infection treatment had no significant effect on the length of hospital stay[SMD=-0.46 d,95%CI(-0.05,0.14)d,P=0.135],the rate of reinfection[RR=0.87,95%CI(0.73,1.03),P=0.105]and the risk of all-cause death[RR=1.02,95%CI(0.80,1.31),P=0.863].ConclusionsPICT-guided antiinfection treatment can reduce the time of antibiotic application in elderly patients,but other clinical effects need to be verified by more large-scale studies.