血清降钙素原监测在门诊治疗社区获得性肺炎中的作用

目的 探讨血清降钙素原(PCT)监测在门诊接受治疗的社区获得性肺炎(CAP)患者的抗生素使用中的临床意义.方法 选2006年11月-2008年2月符合CAP诊断标准的门诊接受治疗的CAP患者127例,随机分为PCT监测组(63例)和常规治疗组(64例),人选患者监测血清PCT水平.在相旧常规治疗的基础上,常规治疗组由经治医师按照我国CAP治疗指南决定抗生素治疗方案;PCT监测组按照血清PCT水平决定是否使用抗生素,在血清PCT≥0.25μg/L时进行抗生素治疗,PCT<0.25μg/L时不予抗生素治疗,之后复诊亦按照此标准决定是否继续使用抗生素.观察2组患者的临床治疗有效率、抗生素使用率、抗生索疗程及抗生素费用.结果 PCT监测组临床治疗有效率(92.1%)与常规治疗组(87.5%)相比差异无统计学意义(P>0.05),PCT监测组的抗生素使用率、抗生素疗程及抗生素费用均低于常规治疗组(P值均小于0.05),2组患者的预后无明显差异.结论 门诊接受治疗的CAP患者可以依据PCT水平指导抗生素应用,能够减少抗生素用量,缩短抗生素疗程,降低抗生素费用.     

Health care‐associated pneumonia in haemodialysis patients: Clinical outcomes in patients treated with narrow versus broad spectrum antibiotic therapy

Background and objective: Although the 2005 American Thoracic Society/Infectious Disease Society of America antibiotic guidelines classify pneumonia occurring in patients receiving chronic haemodialysis as health care‐associated pneumonia (HCAP), and thus recommend treatment with broad‐spectrum antibiotics for these patients, little data support this classification. We compared clinical outcomes in haemodialysis patients hospitalized with pneumonia, who were treated with broad‐spectrum antibiotics versus narrow‐spectrum antibiotics. Methods: One hundred twenty‐five haemodialysis patients with pneumonia met eligibility criteria. Categorization into the community‐acquired pneumonia (CAP) group or HCAP group was based on antibiotic therapy patients received. Time to oral therapy, time to clinical stability, length of stay and mortality were compared. Results: CAP and HCAP patients did not differ in Pneumonia Severity Index and Charlson Comorbidity index scores, but HCAP patients were more likely to meet criteria for severe pneumonia. Patients treated with HCAP therapy had a significantly longer time to oral therapy than CAP patients (9.2 vs 3.2 days, P < 0.001) and a significantly longer length of stay (11.9 vs 5.1 days, P < 0.001). Time to clinical stability was marginally longer in the HCAP group (3.1 vs 2.4 days, P = 0.07). Patients treated with HCAP therapy had longer continuation of intravenous antibiotics after reaching clinical stability (5.5 vs 0.78 days, P < 0.001). Conclusions: This study is the first to our knowledge to describe clinical outcomes in patients with haemodialysis as their only HCAP risk factor. Narrow‐spectrum antibiotics may be safe in haemodialysis patients with no other HCAP risk factors. HCAP therapy delayed de‐escalation to oral antibiotics was associated with increased duration of intravenous antibiotics and length of stay.     

支气管哮喘急性发作时抗生素应用的危险因素分析

目的 分析支气管哮喘（简称哮喘）急性发作患者应用抗生素治疗的危险因素.方法 选取我科2010年6月至201 3年6月间收治的符合分析要求的哮喘急性发作患者97例,全部测定血清降钙素原（PCT）,并随机分为对照组（46例）和治疗组（51例）.在相同的基础治疗上,对照组由经治医师根据经验应用抗生素;治疗组在PCT≥0.25 μg/L时应用抗生素,否则不用.在病例治愈的前提下证明当PCT≥0.25 μg/L时可作为哮喘急性发作时抗生素应用的安全指标.同时记录所有病例入科时的咳痰性状、病情严重程度、体温、C反应蛋白及末梢血白细胞记数作为抗生素应用的可能危险因素.再用该危险因素和以PCT≥0.25 μg/L作为应用抗生素的指标之间做相关性分析.结果 治疗组抗生素应用率（47.1％）比对照组（80.4％）低,差异有统计学意义（P＜0.05）;同时,当PCT≥0.25 μg/L时与咳痰较发作前增加或咳黄脓痰、病情严重程度分级为重-危重度有相关性（P＜0.05）.结论 哮喘急性发作患者,咳痰较发作前增加或咳黄脓痰、病情严重程度分级为重-危重度时需要用抗生素;有发热（P=0.050）则为抗生素应用的临界点,可综合考虑是否应用.而C反应蛋白升高或白细胞升高时则不是应用抗生素的依据.     

Impact of Procalcitonin Guidance with an Educational Program on Management of Adults Hospitalized with Pneumonia

Background

Community-acquired pneumonia and healthcare-associated pneumonia are often treated with prolonged antibiotic therapy. Procalcitonin (PCT) has effectively and safely reduced antibiotic use for pneumonia in controlled studies. However, limited data exist regarding PCT guidance in real-world settings for management of pneumonia.

Usefulness of a semi-quantitative procalcitonin test and the A-DROP Japanese prognostic scale for predicting mortality among adults hospitalized with community-acquired pneumonia

Background and objective: The solid‐phase immunoassay, semi‐quantitative procalcitonin (PCT) test (B R A H M S PCT‐Q) can be used to rapidly categorize PCT levels into four grades. However, the usefulness of this kit for determining the prognosis of adult patients with community‐acquired pneumonia (CAP) is unclear. Methods: A prospective study was conducted in two Japanese hospitals to evaluate the usefulness of this PCT test in determining the prognosis of adult patients with CAP. The accuracy of the age, dehydration, respiratory failure, orientation disturbance, pressure (A‐DROP) scale proposed by the Japanese Respiratory Society for prediction of mortality due to CAP was also investigated. Hospitalized CAP patients (n = 226) were enrolled in the study. Comprehensive examinations were performed to determine PCT and CRP concentrations, disease severity based on the A‐DROP, pneumonia severity index (PSI) and confusion, urea, respiratory rate, blood pressure, age ≥65 (CURB‐65) scales and the causative pathogens. The usefulness of the biomarkers and prognostic scales for predicting each outcome were then examined. Results: Twenty of the 170 eligible patients died. PCT levels were strongly positively correlated with PSI (ρ = 0.56, P < 0.0001), A‐DROP (ρ = 0.61, P < 0.0001) and CURB‐65 scores (ρ = 0.58, P < 0.0001). The areas under the receiver operating characteristic curves (95% CI) for prediction of survival, for CRP, PCT, A‐DROP, CURB‐65, and PSI were 0.54 (0.42–0.67), 0.80 (0.70–0.90), 0.88 (0.82–0.94), 0.88 (0.82–0.94), and 0.89 (0.85–0.94), respectively. The 30‐day mortality among patients who were PCT‐positive (≥0.5 ng/mL) was significantly higher than that among PCT‐negative patients (log–rank test, P < 0.001). Conclusions: The semi‐quantitative PCT test and the A‐DROP scale were found to be useful for predicting mortality in adult patients with CAP.     

降钙素原指导自发性脑出血后卒中相关性肺炎患者的抗生素治疗：随机对照试验

目的：探讨血清降钙素原（ procalcitonin, PCT ）水平在自发性脑出血后卒中相关性肺炎（stroke-associated pneumonia, SAP）抗生素治疗中的指导价值。方法纳入120例急性脑出血后SAP患者并随机分为常规治疗组（n=59）和PCT指导治疗组（n=61）。常规治疗组由经治医生按照中国抗生素使用指南进行抗生素治疗并决定抗生素疗程。 PCT 指导治疗组在使用抗生素5 d后连续监测血清PCT ,当PCT＜0.25μg/L且体温正常时停用抗生素,当PCT≥0.25μg/L时继续使用抗生素,如果PCT＜0.25μg/L但仍有发热,则继续使用抗生素至体温正常。比较2组抗生素疗程、住院时间、30 d病死率。在治疗后90 d时采用改良Rankin量表（modified Rankin Scale, mRS）评价神经功能转归,mRS评分0~2分为转归良好,>2分为转归不良。在出院后进行为期6个月的随访,采用Kaplan-M eier生存曲线比较2组生存率。结果 PCT 指导治疗组抗生素疗程[（8.95±2.73） d对（13.26±4.11） d;t=6.407,P＜0.001]和住院时间[（15.64±2.63） d对（18.36±4.27） d;t=3.967,P＜0.001]均显著短于常规治疗组。 PCT指导治疗组30 d病死率（9.8％对10.1％;χ2=0.003,P=0.951）和90 d时转归良好患者比例（60.6％对59.3％;χ2=0.022, P=0.881）与常规治疗组差异无统计学意义。6个月随访期结束时共有13例（12.0％）死亡,其中常规治疗组6例,PCT 指导治疗组7例。 Kaplan-Meier分析表明,2组6个月生存率无显著性统计学差异（log-rank检验,χ2=0.070,P=0.791）。结论监测血清PCT水平用于指导自发性脑出血后SAP的抗生素治疗是安全的,且能缩短抗生素疗程和住院时间。     

降钙素原在慢性阻塞性肺疾病急性加重期抗感染治疗的应用价值

目的：探讨血清降钙素原（PC T ）在慢性阻塞性肺疾病急性加重期（A EC O PD ）抗生素治疗中的应用价值。方法选择120例 AECOPD老年患者,随机分成3组,分别为 PCT 组（43例）、C反应蛋白（CRP）组（39例）和标准组（38例）。PCT组选择PCT＞0.25μg／L时使用抗生素治疗, PCT＞0.25μg／L停用抗生素;CRP组选择CRP＞20 mg／L 使用抗生素治疗,当复查CRP＜20μg／L停用抗生素;标准组由主治医师根据临床症状决定抗生素的使用及停用。主要研究3组患者临床有效率、抗生素治疗时间、抗生素使用率、住院时间、二重感染率等;同时对比PCT与CRP关系。结果 PCT组、CRP组、标准组患者临床治疗有效率分别为90.7％、87.2％、92.1％,3组比较差异无统计学意义（χ2＝0.555,P ＞0.05）。PCT 组患者抗生素使用率48.8％, CRP组抗生素使用率为59.0％,2组均比标准治疗组89.5％明显降低（χ2＝15.565, P ＜0.05）。PC T组抗生素平均使用天数为（5.9±1.9）d,CRP组为（6.2±2.1）d,均比标准组[（9.0±2.6）d]短（F ＝16.081,P ＜0.05）。住院天数PCT组为（8.6±2.1） d ,CRP组为（8.9±2.1） d ,均比标准治疗组患者[（11.6±3.0）d]短（F ＝18.759,P ＜0.05）。3组的二重感染的发生率（2.3％ vs5.1％ vs10.5％,χ2＝2.522,P ＞0.05）差异无统计学意义。PCT 组与CRP组2组在抗生素有效率、抗生素使用率、抗生素使用时间、住院时间等比较差异无统计学意义。同时,血 PCT 升高,血CRP也随着升高。结论联合检测PCT与CRP可能提高检验的准确性,更好判断AECOPD合并细菌感染指征,减少抗生素使用时间及费用,减少住院时间。     

血清降钙素原对AECOPD抗生素使用的指导价值

目的研究血清降钙素原(PCT)检测在慢性阻塞性肺疾病急性加重期(AECOPD)对使用抗生素的指导价值。方法选取收治的AECOPD患者63例,随机分配成两组:PCT指导治疗组32例(简称PCT组)和常规治疗组31例(简称对照组),检测血清PCT水平。在常规治疗的基础上,对照组按照临床抗生素使用指南决定抗生素疗程,PCT组按照血清PCT水平决定抗生素的使用,当血清PCT≥0.25ng/mL时,进行抗生素治疗,当PCT0.25 ng/mL时,则停止使用抗生素。并观察两组患者抗生素的使用疗程,抗生素所用费用及住院时间。结果 PCT组抗生素疗程[7(5~11)d]短于对照组[13(7~16)d](P=0.03);PCT组抗生素费用低于对照组(P=0.001),两组的住院时间及预后无明显差异。结论 AECOPD患者根据PCT水平使用抗生素,能够明显缩短抗生素的所用疗程,减少医疗费用。     

血清降钙素原对 AECOPD 抗生素应用的指导价值简

目的 探讨血清降钙素原对慢性阻塞性肺疾病急性加重抗生素应用的指导价值.方法 112 例慢性阻塞性肺疾病急性加重患者分为3组,PCT指导治疗组（37例）和常规治疗组（40例）、非抗生素治疗组（35例）.在相同常规治疗基础上,PCT组根据血清PCT水平决定抗生素的使用,当0.25ng/ml时停止使用抗生素.常规组由医师根据临床经验结合患者症状决定抗生素疗程.观察指标为抗生素的使用天数、住院时间、临床有效率.结果 PCT组平均抗生素使用时间、平均住院时间明显短于常规治疗组,而两组临床有效率无显著性差异.结论 对慢性阻塞性肺疾病急性加重患者根据PCT使用抗生素,能够缩短抗生素疗程,减少平均住院时间,不影响临床有效率.     

Serum hydrogen sulfide as a novel marker predicting bacterial involvement in patients with community-acquired lower respiratory tract infections

Background and objective: Endogenous hydrogen sulfide (H₂S) may be involved in the pathogenesis of systemic inflammation. It was investigated whether serum H₂S levels differed among patients with community‐acquired pneumonia, those with exacerbations of COPD or control subjects, and whether H₂S may be used as a surrogate marker of the need for antibiotic treatment. Methods: Serum H₂S levels were measured in 129 patients with pneumonia or COPD exacerbations and in 72 healthy control subjects. Results: The mean serum H₂S concentration was 36% lower in patients with pneumonia (22.7 ± 14.6 µmol/L) than in control subjects (35.4 ± 5.3 µmol/L) (P < 0.01). Serum H₂S concentration did not differ between patients with acute exacerbations of COPD (33.8 ± 18.6 µmol/L) and control subjects. Within the COPD group, patients with Anthonisen type 1 exacerbations had a lower serum H₂S concentration (22.5 ± 11.6 µmol/L) than control subjects, and those with type 3 exacerbations had a higher serum H₂S concentration (54.2 ± 21.3 µmol/L) than control subjects. There was no difference between patients with type 2 exacerbations (41.7 ± 8.4 µmol/L) and control subjects. In patients requiring antibiotics, serum H₂S concentration was 41% lower than in those not requiring antibiotics. The area under the receiver operating characteristic curve for H₂S as a surrogate marker of the need for antibiotics was 0.862 (95% confidence interval: 0.805–0.919, P < 0.01). Serum H₂S levels were inversely correlated with serum CRP levels (r = ?0.337, P < 0.01). Conclusions: Serum H₂S levels may be used as a marker in lower respiratory tract infections. Further studies are required to validate the role of serum H₂S levels in guiding antibiotic selection.     

血清降钙素原检测指导支气管哮喘急性发作抗生素应用的价值

目的探讨血清降钙素原(PCT)指导支气管哮喘急性发作患者抗生素应用的意义。方法将83例住院支气管哮喘急性发作患者随机分为PCT组和对照组。PCT组在入院1 h内以及第3、5、7天时分别检测PCT水平,当PCT0.1μg/L时停用抗生素,若PCT≥0.1μg/L则继续应用。对照组依据支气管哮喘防治指南使用抗生素。结果 PCT组和对照组抗生素使用天数分别为(5.6±1.5)和(7.9±2.1)(P0.01),住院时间为(7.5±2.4)和(10.0±1.7)(P0.01),住院费用(元)为(3902±493)和(5367±438)(P0.01),抗生素费用(元)为(1417±322)和(1860±337)(P0.01)。两组之间临床有效率和1个月随访期间急性发作发生率的差异无统计学意义。结论根据PCT水平使用抗生素有助于减少支气管哮喘患者抗生素的应用。     

Prognostic value of procalcitonin in pneumonia: A systematic review and meta‐analysis

This meta‐analysis was performed to determine the accuracy of procalcitonin (PCT) in predicting mortality in pneumonia patients with different pathogenic features and disease severities. A systematic search of English‐language articles was performed using PubMed, Embase, Web of Knowledge and the Cochrane Library to identify studies. The diagnostic value of PCT in predicting prognosis was determined using a bivariate meta‐analysis model. The Q‐test and I² index were used to test heterogeneity. A total of 21 studies comprising 6007 patients were included. An elevated PCT level was a risk factor for death from community‐acquired pneumonia (CAP) (risk ratio (RR) 4.38, 95% confidence interval (CI) 2.98–6.43), particularly in patients with a low CURB‐65 score. The commonly used cut‐off, 0.5 ng/mL, had low sensitivity (SEN) and was not able to identify patients at high risk of dying. Furthermore, the PCT assay with functional SEN <0.1 ng/mL was necessary to predict mortality in CAP in the clinic. For critically ill patients, an elevated PCT level was associated with an increased risk of mortality (RR 4.18, 95% CI: 3.19–5.48). The prognostic performance was nearly equal between patients with ventilator‐associated pneumonia (VAP) and patients with CAP.     

SWAB/NVALT (Dutch Working Party on Antibiotic Policy and Dutch Association of Chest Physicians) guidelines on the management of community-acquired pneumonia in adults

The Dutch Working Party on Antibiotic Policy (SWAB) and the Dutch Association of Chest Physicians (NVALT) convened a joint committee to develop evidence-based guidelines on the diagnosis and treatment of community acquired pneumonia (CAP). The guidelines are intended for adult patients with CAP who present at the hospital and are treated as outpatients as well as for hospitalised patients up to 72 hours after admission. Areas covered include current patterns of epidemiology and antibiotic resistance of causative agents of CAP in the Netherlands, the possibility to predict the causative agent of CAP on the basis of clinical data at first presentation, risk factors associated with specific pathogens, the importance of the severity of disease upon presentation for choice of initial treatment, the role of rapid diagnostic tests in treatment decisions, the optimal initial empiric treatment and treatment when a specific pathogen has been identified, the timeframe in which the first dose of antibiotics should be given, optimal duration of antibiotic treatment and antibiotic switch from the intravenous to the oral route. Additional recommendations are made on the role of radiological investigations in the diagnostic work-up of patients with a clinical suspicion of CAP, on the potential benefit of adjunctive immunotherapy, and on the policy for patients with parapneumonic effusions.     

Procalcitonin and C-Reactive Protein Levels in Community-Acquired Pneumonia: Correlation with Etiology and Prognosis

Summary Background: The diagnostic value of admission serum levels of procalcitonin (PCT) and C-reactive protein (CRP) as indicators of the etiology and prognosis was prospectively investigated. Patients: 96 patients, 50–85 years of age, treated in the hospital for community-acquired pneumonia (CAP). Results: On admission, all patients had elevated CRP levels (> 10 mg/l), but only 60 patients (54%) had elevated PCT levels (> 0.1 μg/l). The severity of disease measured by APACHE II score was strongly associated with admission levels of PCT (p = 0.006), but not with CRP. Eight of nine patients with pneumonia caused by atypical agents had PCT levels < 0.5 μg/l compared with 6/27 patients with pneumonia caused by classical bacterial pathogens, mainly Streptococcus pneumoniae (p = 0.03). No such correlation between CRP levels and etiology was found. Conclusion: Our data indicate that in patients admitted to the hospital with CAP, measurement of PCT gives information about the severity of the disease, and may aid the physician to differentiate typical bacterial etiology from atypical etiology, and thereby to choose appropriate initial antibiotic treatment. Received: June 7, 1999 · Revision accepted: January 17, 2000     

Venous thromboembolism in patients with hematologic malignancy and thrombocytopenia

The optimal management of hematologic malignancy‐associated venous thromboembolism (VTE) in patients with moderate‐to‐severe thrombocytopenia is unclear. This is a retrospective study of 128 adult patients with hematologic malignancies who were diagnosed with VTE. The outcome of patients with significant thrombocytopenia (≤50,000/µL) was compared with those without. Forty‐seven patients (36.7%) had a platelet count ≤50,000/µL during a period of time of perceived need for new or continued anticoagulation. The median nadir platelet count in those with significant thrombocytopenia was 10,000/µL (range 2,000–45,000/µL) versus 165,000/µL (50,000–429,000/µL) in those without (P < 0.001). The median duration of significant thrombocytopenia in the first group was 10 days (1–35 days). Therapy during the period of significant thrombocytopenia included prophylactic‐dose low‐molecular‐weight heparin ( LMWH) (47%), therapeutic‐dose LMWH or heparin (30%), warfarin (2%), inferior vena cava filter (2%), and observation (17%). Patients without thrombocytopenia were managed with the standard of care therapy. At a median follow‐up of more than 2 years, the risk of clinically significant bleeding (11% vs 6%, P = 0.22) including major bleeding (6% vs 2%) and clot progression or recurrence (21% vs 22%, P = 1.00) were similar in patients with or without significant thrombocytopenia. In a multivariate analysis, the risk of recurrence/progression (hazard ratio, HR 0.59, 95% CI 0.21–1.66, P = 0.31) and hemorrhage rate (HR 0.29, 95% CI 0.05–1.56, P = 0.15) did not differ based on the presence of significant thrombocytopenia. Within the limits of this retrospective study, cautious use of prophylactic‐dose LMWH may be safe in thrombocytopenic patients with hematologic malignancy‐associated VTE. Am. J. Hematol. 91:E468–E472, 2016. © 2016 Wiley Periodicals, Inc.     

Role of 'atypical pathogens' among adult hospitalized patients with community-acquired pneumonia

Background and objective: Agents such as Mycoplasma pneumoniae, Chlamydophila pneumoniae and Legionella pneumophila are recognized as important causes of community‐acquired pneumonia (CAP) worldwide. This study examined the role of these ‘atypical pathogens’ (AP) among adult hospitalized patients with CAP. Methods: A prospective, observational study of consecutive adult CAP (clinico‐radiological diagnosis) patients hospitalized during 2004–2005 was conducted. Causal organisms were determined using cultures, antigen testing and paired serology. Clinical/laboratory/radiological variables and outcomes were compared between different aetiologies, and a clinical prediction rule for AP was constructed. Results: There were 1193 patients studied (mean age 70.8 ± 18.0 years, men 59.3%). Causal organisms were identified in 468 (39.2%) patients: ‘bacterial’ (48.7%), ‘viral’ (26.9%), ‘AP’ (28.6%). The AP infections comprised Mycoplasma or Chlamydophila pneumoniae (97.8%) and co‐infection with bacteria/virus (30.6%). The majority of AP infections involved elderly patients (63.4%) with comorbidities (41.8%), and more than one‐third of patients were classified as ‘intermediate’ or ‘high’ risk CAP on presentation (pneumonia severity index IV–V (35.1%); CURB‐65 2–5 (42.5%)). Patients with AP infections had disease severities and outcomes similar to patients with CAP due to other organisms (oxygen therapy 29.1% vs 29.8%; non‐invasive ventilation 3.7% vs 3.3%; admission to the intensive care unit 4.5% vs 2.7%; length of hospitalization 6 day vs 7 day; 30‐day mortality: 2.2% vs 6.0%; overall P > 0.05). Age <65 years, female gender, fever ≥38.0°C, respiratory rate <25/min, pulse rate <100/min, serum sodium >130 mmol/L, leucocyte count <11 × 10⁹/L and Hb < 11 g/dL were features associated with AP infection, but the derived prediction rule failed to reliably discriminate CAP caused by AP from bacterial CAP (area under the curve 0.75). Conclusions: M. pneumoniae and C. pneumoniae as single/co‐pathogens are important causes of severe pneumonia among older adults. No reliable clinical indicators exist, so empirical antibiotic coverage for hospitalized CAP patients may need to be considered.     

血清降钙素原测定对合理应用抗生素治疗AECOPD的作用

目的评价降钙素原(procalcitonin,PCT)对AECOPD合并的细菌感染临床应用价值。方法 2009年6月至2010年5月在我院呼吸科入院AECOPD患者109例,随机分成PCT组(n=52)和常规治疗组(n=57),常规治疗组按常规治疗方法使用抗生素进行治疗,PCT组通过血清PCT测定来指导抗生素使用,比较两组抗生素使用时间、使用率、临床有效率、患者住院费用、住院时间及抗生素治疗结束后两组患者炎性指标(白细胞总数、中性粒细胞数、CRP)之间的差异。结果两组治疗后PCT组患者白细胞总数、中性粒细胞数、CRP与常规治疗组差异无统计学意义,两组治疗后白细胞总数、中性粒细胞数、CRP均较治疗前下降,同时抗生素使用时间、抗生素使用率、患者住院费用及住院时间常规组与PCT组差异有统计学意义,PCT组抗生素使用率明显低于常规治疗组。结论在AECOPD治疗中参考PCT水平应用抗生素可以达到有效治疗效果,而避免过度使用抗生素。     

Highly sensitive AFP-L3% assay is useful for predicting recurrence of hepatocellular carcinoma after curative treatment pre- and postoperatively

Aim: The micro‐total analysis system (µTAS), a fully automated immunoassay system using microchip capillary electrophoresis, is highly sensitive and able to quickly assay the AFP‐L3%. The clinical usefulness of this system was studied. Methods: We retrospectively enrolled 250 patients who underwent curative treatment for primary hepatocellular carcinoma (HCC) (93 patients underwent hepatic resection and 157, radiofrequency ablation [RFA]). Results: The sensitivity for µTAS AFP‐L3% was 40.3% at the cutoff value of 5% in a range of AFP less than 20 ng/mL where the conventional method was unable to determine AFP‐L3%. The sensitivity for AFP‐L3% remained high even at stage I and at tumor size less than 2 cm (42.5% and 46.0%, respectively). Recurrence rate of patients with AFP‐L3% greater than 5% was significantly higher than that of patients with less than 5% (P = 0.001). Furthermore, in resected patients, the postoperative AFP‐L3% remained elevated with value greater than 5% was related to HCC recurrence (P = 0.001). Multivariate analysis revealed that multiple tumors (P = 0.004), preoperative AFP‐L3% greater than 5% (P = 0.003), albumin less than 3.5 g/dL (P = 0.008), and RFA (P = 0.003) were significant prognostic factors of recurrence. Conclusions: The µTAS was found to be a highly sensitive assay for AFP‐L3% in patients with curative treatment of HCC. A cutoff value of 5% was useful for predicting recurrence after the curative treatment and detecting small tumors and early stage HCC. Additionally, postoperative AFP‐L3% was found to be a prognostic factor of HCC recurrence.     

Use of Commonly Prescribed Antibiotics Is Not Associated with Prevalence of Helicobacter pylori Infection in Adults

Background: The aim of the study was to investigate the association of the use of commonly prescribed antibiotics with prevalence of Helicobacter pylori infection in a population of adult outpatients. Methods: All patients aged 15–79 years who visited the practice of a general practitioner (GP) between June and September 1996 in a suburban community near Ulm, a city in southern Germany, were asked to participate in the study. Infection status was determined with a ^l3C-urea breath test. In addition, the patients were asked to fill out a self-administered questionnaire. Results: Overall, 475 outpatients were included in the study (response, 94.1%). A total of 266 patients (56.0%) reported a history of antibiotic treatment within the past 5 years, whereas 147 patients (30.9%) did not (62 patients (13.1%) did not know). Prevalence of infection in patients with a history of antibiotic medication during the past 5 years was 23.3%, whereas the prevalence of infection was 20.4% in subjects without antibiotic treatment (P = 0.283 after stratification for age). Control for other potential confounders by multivariable analysis did not materially alter the results. Conclusion: Coincidental antibiotic treatment is not associated with H. pylori prevalence in adults.