血清降钙素原水平检测在慢性阻塞性肺疾病急性加重期患者抗菌治疗中的指导意义

目的探讨血清降钙素原（PCT）水平检测在慢性阻塞性肺疾病急性加重期（AECOPD）患者合理应用抗菌药物中的指导作用。方法选取2010年10月—2012年2月住院的AECOPD患者63例，随机分为A组35例（PCT指导治疗）和B组28例（经验治疗）。A组根据血清PCT水平决定是否使用抗菌药物，PCTI〉0．25ng／mL时使用抗菌药物，PCT〈0．25．g／mL停用抗菌药物；B组由经治医师根据AECOPD患者临床表现、WBC计数及严重程度决定抗菌药物的使用。测定2组患者出入院时PCT水平，比较2组患者的抗菌药物使用时间、住院时间、临床有效率、住院总费用、抗菌药物费用、加重例数、死亡例数等指标。结果2组患者的性别、年龄、吸烟史、COPD病程、体温、严重程度分级及实验室指标等比较均无显著差异（P〉0．05）；A组患者治疗前后的PCT值分别为（0．225±0．382）ng／mL和（0．076±0．044）rig／mL，治疗前后比较差异有统计学意义（P〈0．01）；2组患者在临床有效率、加重例数、死亡例数等方面比较无显著差异（P=0．667、1．000、1．000）；2组抗菌药物使用时间比较有显著差异（P〈0．01），A组抗菌药物使用时间为（7．43±4．69）d，而B组为（12．64±4．01）d；A组的抗菌药物费用、住院总费用、住院时间均低于B组（P=0．019、0．020、0．027）。结论根据血清PCT水平来指导AECOPD患者抗菌药物使用，有可能避免抗菌药物过度使用，从而降低抗菌药物使用费用和住院总费用，缩短住院时间。

Clinical significance of serum procalcitonin detection in antibiotic treatment of patients with acute exacerbation of chronic obstructive pulmonary disease

Objective To explore the clinical significance of serum procalcitonin（PCT） de tection in the antibiotic treatment of patients with acute exacerbations of chronic obstructive pulmonary disease（AECOPD）. Methods 63 hospitalized patients with AECOPD from October 2010 to February 2012 were randomly divided into group A （n =35, PCT guided treatment） and group B （n =28, ex periential treatment）. Group A was treated with antibiotics according to level of serum PCT. When PCT level I〉 0.25 ng/mL, antibiotic treatment was applied; if PCT level 〈 0.25 ng/mL, antibiotic treatment were stopped. Group B was treated with antibiotic treatment according to clinical manifesta tion, the number of WBC and the severity of COPD. Level of PCT was detected in the periods of hospi tal admission and hospital discharge. Indexes such as length of antibiotics use, length of hospitaliza tion, clinical efficacy, costs of hospitalization, costs of antibiotics, the numbers of aggravated cases and deaths were analyzed. Results There were no significant differences of age, gender, smoking history , duration of COPD , fever , severity of COPD and laboratory index between the two groups （ P 〉 0 . 05 ） ; pretherapeuticPCTlevelwas （ 0. 225 ± 0. 382 ） ng/mLinthegroupA, whichwas significantlyhigher than （0. 076 ＋0. 044） ng/mL after treatment in the same group （P 〈0.01 ） ; there were no significant differences of elinieal efficacy, the numbers of aggravated eases and deaths between the two groups （ P = 0. 667, 1. 000, 1. 000） ; length of antibiotics use was （7.43 ＋_ 4.69 ） days in the group A, which was significantly shorter than （ 12.64 _＋ 4.01 ） days in the group B （ P 〈 0.01 ） ; costs of antibotics, costs of hospitalization and length of hospi talization in the group A were signifi cantly lower and shorter than those in the group B （P =0.019, 0. 020, 0.027）. Conclusion Jud ging the application of antibiotics in the treatment of patients with AECOPD according to PCT level can avoid overuse of antibiotics, reduce costs of antibiotics and hospitalization and shorten length of hospitalization.