监测血液病伴不明原因发热患者血清降钙素在临床应用的探讨

目的 探讨血液病患者不明原因发热(FUO)的血清降钙素(PCT)水平值,对指导优化抗菌药物使用方案,以及在临床的应用价值。方法 将80例患者分成对照组及试验组。试验组采用快速半定量法(PCT-Q)检测,观察治疗前后PCT水平值的变化,与对照组比较,分析血液病FUO患者的PCT水平值与FUO的关系。结果 患者血清中PCT水平值与抗菌药物优化前后使用的方案对比,试验组患者使用抗菌药物天数/住院天数的比值明显低于对照组,差异有统计学意义(P<0.05);抗菌药使用强度(AUD),呈波浪形逐月下降趋势。结论 PCT水平值能及时、准确、有效地鉴别血液病患者的FUO,便于医师与临床药师及时、准确地在患病早期,选用最合适的抗菌药物对症治疗,降低AUD。

Clinical value of Procalcitonin monitoring in patients with blood disorders complicated with fever of unknown origin

Objective To determine the serum level of Procalcitonin （PCT） in patients with blood disorders complicated with fever of unknown origin （FUO）, so as to guide optimization of antibacterial use, and to explore the clinical value of PCT monitoring. Methods Eighty patients were divided into the control group on routine treatment and the experimental group on optimized therapy. Rapid semi-quantitative detection of PCT （PCT-Q） was performed in experimental group at baseline and after treatment. The results were compared with those from the control group. The correlation between PCT and FUO in these patients was analyzed. Results Discontinuation of antimicrobials in the experimental group was based on level of serum PCT. Compared with the control group, the experimental group showed significantly reduced ratio of days on antimicrobials over length of hospital stay, with statistical difference between groups （P0.05）. In addition, the antimicrobial use density （AUD） in the experimental group showed a trend of wavy decline over months. Conclusion Monitoring of PCT level may enable timely, accurate and effective identification of FUO in patients with blood disorders, and may guide optimal antimicrobial use at the early stage of the condition by physicians and pharmacists in order to reduce AUD.