血清降钙素原水平在优化慢性阻塞性肺疾病急性加重期抗感染治疗中的意义

Significance of serum procalcitonin level in optimizing anti-infection therapy in acute exacerbation of chronic obstructive pulmonary disease

目的探讨慢性阻塞性肺疾病急性加重期患者血清降钙素原(PCT)水平在优化抗感染治疗中的意义。方法100例慢性阻塞性肺疾病急性加重期患者,依据抗感染治疗方法不同分为血清PCT指导组和常规临床经验组,各50例。常规临床经验组依据抗生素治疗指南、白细胞计数(WBC)、临床表现应用抗生素,血清PCT指导组依据血清PCT水平应用抗生素。比较两组肺功能分级,急性加重症状分度,抗生素应用情况,血清炎性指标[C反应蛋白(CRP)、PCT、血沉(ESR)、WBC、中性粒细胞]水平、血气分析[血氧饱和度(SaO_(2))、氧分压(PO_(2))、二氧化碳分压(PCO_(2))]值,临床疗效,首次再发时间、住院时间、住院总费用,二重感染、转入重症加强护理病房(ICU)及半年内复发情况。结果治疗后,两组患者的肺功能分级均优于本组治疗前,血清PCT指导组患者的肺功能分级优于常规临床经验组,差异具有统计学意义(P<0.05)。治疗后,两组患者的急性加重症状分度均优于本组治疗前,血清PCT指导组患者的急性加重症状分度优于常规临床经验组,差异具有统计学意义(P<0.05)。血清PCT指导组患者的抗生素应用率60.00%(30/50)低于常规临床经验组的94.00%(47/50),差异具有统计学意义(χ^(2)=16.318,P<0.05);血清PCT指导组患者的抗生素平均疗程(6.30±1.14)d短于常规临床经验组的(9.50±1.30)d,差异具有统计学意义(t=13.087,P<0.05);血清PCT指导组患者的抗生素人均费用(2034.13±340.33)元低于常规临床经验组的(3142.25±534.24)元,差异具有统计学意义(t=12.370,P<0.05)。血清PCT指导组患者治疗前的血清CRP、PCT、ESR、WBC、中性粒细胞、SaO_(2)、PO_(2)、PCO_(2)分别为(30.00±5.81)mg/L、(2.03±0.32)ng/ml、(23.35±3.46)mm/h、(10.00±1.30)×10^(9)/L、(0.81±0.06)、(91.87±4.85)%、(65.00±11.45)mm Hg(1 mm Hg=0.133 kPa)、(57.35±8.67)mm Hg,治疗后分别为(12.88±2.11)mg/L、(1.75±0.32)ng/ml、(18.25±3.36)mm/h、(7.04±1.60)×10^(9)/L、(0.67±0.03)、(95.10±3.60)%、(85.92±8.33)mm Hg、(46.85±5.03)mm Hg;常规临床经验组患者治疗前的血清CRP、PCT、ESR、WBC、中性粒细胞、SaO_(2)、PO_(2)、PCO_(2)分别为(29.20±4.04)mg/L、(2.05±0.30)ng/ml、(23.52±3.16)mm/h、(9.97±1.80)×10^(9)/L、(0.80±0.04)、(91.23±4.11)%、(63.46±13.40)mm Hg、(58.23±9.80)mm Hg,治疗后分别为(14.15±2.00)mg/L、(1.86±0.15)ng/ml、(20.10±3.12)mm/h、(8.31±1.23)×10^(9)/L、(0.77±0.05)、(93.77±2.77)%、(76.50±8.21)mm Hg、(52.71±7.41)mm Hg。治疗前,两组患者的血清CRP、PCT、ESR、WBC、中性粒细胞、SaO_(2)、PO_(2)、PCO_(2)水平比较差异均无统计学意义(P>0.05);治疗后,两组患者的血清CRP、PCT、ESR、WBC、中性粒细胞、PCO_(2)水平均低于治疗前,SaO_(2)、PO_(2)水平均高于治疗前,血清PCT指导组患者的血清CRP、PCT、ESR、WBC、中性粒细胞、PCO_(2)水平均低于常规临床经验组,SaO_(2)、PO_(2)水平均高于常规临床经验组,差异具有统计学意义(P<0.05)。血清PCT指导组患者的总有效率90.00%(45/50)高于常规临床经验组的66.00%(33/50),差异具有统计学意义(χ^(2)=8.392,P<0.05)。血清PCT指导组患者的首次再发时间(5.16±0.86)个月长于常规临床经验组的(4.38±0.64)个月,差异具有统计学意义(t=5.145,P<0.05);血清PCT指导组患者的住院时间(10.44±1.24)d短于常规临床经验组的(12.41±2.53)d,差异具有统计学意义(t=4.944,P<0.05);血清PCT指导组患者的住院总费用(8736.14±1245.13)元低于常规临床经验组的(11242.12±435.23)元,差异具有统计学意义(t=13.434,P<0.05)。血清PCT指导组患者的二重感染率、转入ICU率分别为2.00%(1/50)、8.00%(4/50),均低于常规临床经验组的16.00%(8/50)、26.00%(13/50),差异具有统计学意义(P<0.05);但两组患者的半年内复发率比较差异无统计学意义(P>0.05)。结论慢性阻塞性肺疾病急性加重期患者血清PCT水平在抗感染治疗中的指导意义重大。

Objective To discuss the significance of serum procalcitonin(PCT)level in optimizing anti-infection therapy in acute exacerbation of chronic obstructive pulmonary disease.Methods A total of 100 patients with acute exacerbation of chronic obstructive pulmonary disease were divided into serum PCT guidance group and conventional clinical experience group according to different anti-infection treatment methods,with 50 cases in each group.The conventional clinical experience group applied antibiotics according to the guidelines for antibiotic treatment,white blood cell count(WBC)and clinical manifestations,and the serum PCT guidance group applied antibiotic according to the serum PCT level.Both groups were compared in terms of pulmonary function classification,acute exacerbation symptom grading,antibiotic application,serum inflammatory index[C-reactive protein(CRP),PCT,erythrocyte sedimentation rate(ESR),WBC,neutrophils]levels,blood gas analysis[blood oxygen saturation(SaO_(2)),arterial partial pressure of oxygen(PO_(2)),arterial partial pressure of carbon dioxide(PCO_(2))],clinical efficacy,time to first recurrence,length of hospital stay,total hospitalization cost,dual infection,intensive care unit(ICU)transfer and recurrence within 6 months.Results After treatment,the pulmonary function classification in both groups was better than that before treatment in this group,and the pulmonary function classification in serum PCT guidance group was better than that in conventional clinical experience group.The differences were statistically significant(P<0.05).After treatment,the acute aggravation symptom grading in both groups was better than that before treatment in this group,and the acute aggravation symptom grading in serum PCT guidance group was better than that in conventional clinical experience group.The difference were statistically significant(P<0.05).The antibiotic application rate of 60.00%(30/50)in serum PCT guidance group was lower than that of 94.00%(47/50)in conventional clinical experience group,and the difference was statistically significant(χ^(2)=16.318,P<0.05).The average course of antibiotics of(6.30±1.14)d in serum PCT guidance group was shorter than that of(9.50±1.30)d in conventional clinical experience group,and the difference was statistically significant(t=13.087,P<0.05).The per capita cost of antibiotics of(2034.13±340.33)yuan in serum PCT guidance group was lower than that of(3142.25±534.24)yuan in conventional clinical experience group,and the difference was statistically significant(t=12.370,P<0.05).In serum PCT guidance group,the serum CRP,PCT,ESR,WBC,neutrophil,SaO_(2),PO_(2)and PCO_(2)were(30.00±5.81)mg/L,(2.03±0.32)ng/ml,(23.35±3.46)mm/h,(10.00±1.30)×10^(9)/L,(0.81±0.06),(91.87±4.85)%,(65.00±11.45)mm Hg(1 mm Hg=0.133 kPa)and(57.35±8.67)mm Hg before treatment,and those were(12.88±2.11)mg/L,(1.75±0.32)ng/ml,(18.25±3.36)mm/h,(7.04±1.60)×10^(9)/L,(0.67±0.03),(95.10±3.60)%,(85.92±8.33)mm Hg and(46.85±5.03)mm Hg after treatment.In conventional clinical experience group,the serum CRP,PCT,ESR,WBC,neutrophils,SaO_(2),PO_(2)and PCO_(2)were(29.20±4.04)mg/L,(2.05±0.30)ng/ml,(23.52±3.16)mm/h,(9.97±1.80)×10^(9)/L,(0.80±0.04),(91.23±4.11)%,(63.46±13.40)mm Hg and(58.23±9.80)mm Hg before treatment,and those were(14.15±2.00)mg/L,(1.86±0.15)ng/ml,(20.10±3.12)mm/h,(8.31±1.23)×10^(9)/L,(0.77±0.05),(93.77±2.77)%,(76.50±8.21)mm Hg and(52.71±7.41)mm Hg after treatment.Before treatment,there were no statistically significant differences in serum CRP,PCT,ESR,WBC,neutrophil,SaO_(2),PO_(2)and PCO_(2)levels between the two groups(P>0.05).After treatment,the serum levels of CRP,PCT,ESR,WBC,neutrophils and PCO_(2)in both groups were lower than those before treatment in this group,while the levels of SaO_(2)and PO_(2)were higher than those before treatment in this group;the serum levels of CRP,PCT,ESR,WBC,neutrophils and PCO_(2)in serum PCT guidance group were lower than those in conventional clinical experience group,while the levels of SaO_(2)and PO_(2)were higher than those in conventional clinical experience group;the differences were statistically significant(P<0.05).The total effective rate of 90.00%(45/50)in serum PCT guidance group was higher than that of 66.00%(33/50)in conventional clinical experience group,and the difference was statistically significant(χ^(2)=8.392,P<0.05).The time to first recurrence of(5.16±0.86)months in serum PCT guidance group was longer than that of(4.38±0.64)months in conventional clinical experience group,and the difference was statistically significant(t=5.145,P<0.05).The length of hospital stay of(10.44±1.24)d in serum PCT guidance group was shorter than that of(12.41±2.53)d in conventional clinical experience group,and the difference was statistically significant(t=4.944,P<0.05).The total hospitalization cost of(8736.14±1245.13)yuan in serum PCT guidance group was lower than that of(11242.12±435.23)yuan in conventional clinical experience group,and the difference was statistically significant(t=13.434,P<0.05).The dual infection rate and ICU transfer rate in serum PCT guidance group were 2.00%(1/50)and 8.00%(4/50),which were lower than those of 16.00%(8/50)and 26.00%(13/50)in conventional clinical experience group,and the differences were statistically significant(P<0.05).However,there was no statistically significant difference in the recurrence rate within 6 months between the two groups(P>0.05).Conclusion The level of serum PCT in patients with acute exacerbation of chronic obstructive pulmonary disease is of great significance in the guidance of anti-infection therapy.