降钙素原在慢性阻塞性肺疾病急性加重期优化抗生素使用的意义

目的评价降钙素原在慢性阻塞性肺疾病急性加重期(AECOPD)优化抗生素使用的临床意义。方法选择从2012年10月至2013年12月于我院就诊的100例AECOPD患者,随机分为试验组50例和对照组50例,对照组按照患者症状、抗生素使用指南和医生经验使用抗生素,试验组采用电化学发光法分别于患者治疗第1、4、7、10 d检测降钙素原(PCT),根据血清PCT≥0.25μg/L为截断值,使用抗生素,血清PCT<0.25μg/L不使用或停用抗生素。观察两组患者的抗生素使用情况,患者的平均住院时间,临床治疗有效率及二重感染的发生率。结果试验组患者的抗生素使用率为70.0%,对照组患者的抗生素使用率为88.0%,两组患者的抗生素使用率比较,差异有统计学意义(χ2=4.8825,P=0.0271)。试验组患者抗生素使用10天以上的发生率明显低于对照组,差异也有统计学意义(χ2=4.3738,P=0.0365)。试验组患者的平均住院时间为(12.4±2.6)d,对照组患者的平均住院时间为(16.7±3.3)d,两组患者平均住院时间比较,差异有统计学意义(t=7.2374,P=0.0000)。试验组患者的临床治疗有效率为90.0%,对照组患者的临床治疗有效率为84.0%,两组患者临床治疗有效率比较,差异无明显统计学意义(χ2=0.7958,P=0.3724)。试验组患者的二重感染率为4.0%,对照组患者的二重感染率为20.0%,两组患者二重感染率比较,差异有统计学意义(χ2=6.0606,P=0.0138)。结论降钙素原在评价AECOPD是否使用抗生素时有一定的指导作用,可以明显缩短抗生素的使用时间和使用率,在保证临床疗效的同时降低二重感染率。

Procalcitonin in Patients with Chronic Obstructive Pulmonary Disease to Optimize the Use of Antibiotics Significance

Objective To analyze the Procalcitonin （PCT） in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD）, to optimize the clinical use of antibiotics. Methods 100 patients with AECOPD were randomly divided into experimental group and control group, with 50 cases in each group. The control group were applied with antibiotics according to the patient＇s symptoms, antibiotic guiding, doctors＇ experience. While the experimental group were treated with antibiotics according to the detection results of the PCT values on the 1~, 4~, 7~, 10~ by delectrochemiluminescence immunoassay. When the serum PCT ~〉 0.25/zg, antibiotics were used. The primary outcome was a composite of the use of antibiotic, the average length of stay of patients, the incidence of clinical treatment efficiency and superinfection. Results The use of antibiotics of the experimental group was 70.0%, while that of the control group was 88.0%. The use of antibiotics in the experimental group was significantly lower （X2 = 4.882 5, P= 0.027 1）. Antibiotic use for more than 10 days in the experimental group was significantly lower than that in the control group （X2 = 4.373 8, P = 0.036 5）. The average length of stay for patients in the experimental group was （12.4 ± 2.6） d, significantly shorter than （16.7 ± 3.3） d in the control group （t = 7.237 4, P= 0.000 0）. But the clinical effective rate of the experimental group and the control group was of no statistical significance （~2 = 0.795 8, P = 0.372 4）. Superinfection in the test group was lower than that in the control group （X2 = 6.060 6, P = 0.013 8）. Conclusions Procalcitonin has some guidance in evaluating the use of antibiotics in treating AECOPD. It can significantly shorten the time and usage of antibiotics, and ensure clinical efficacy while reducing superinfection rate.