血清降钙素原测定对合理应用抗菌药物治疗老年慢性阻塞性肺疾病急性加重期的指导价值

Guiding value of procalcitonin in rational antiobiotic therapy for the elderly with acute exacerbation of chronic obstructive pulmonary disease

摘要:

目的 探讨检测血清降钙素原（PCT）对老年慢性阻塞性肺疾病急性加重期（AECOPD）患者合并细菌感染的临床应用价值。方法 选取2012年7月至2013年1月在解放军总医院第一附属医院呼吸科住院的老年AECOPD患者140例，随机分为PCT指导治疗组（n=72）和常规治疗组（n=68），在相同常规治疗基础上，PCT组通过血清PCT测定来指导抗菌药物的使用，常规治疗组由医师根据临床经验结合患者症状使用抗菌药物进行治疗，比较两组抗菌药物使用时间、临床有效率、患者住院费用、抗菌药物费用、住院时间及抗生素治疗结束后两组患者炎性指标［白细胞总数和C反应蛋白（CRP）］之间的差异。结果 两组治疗后PCT组患者白细胞总数和CRP与常规治疗组差异均无统计学意义（P＞0.05），但PCT组患者住院时间与常规治疗组相比明显缩短（P＜0.01），住院费用及抗菌药物费用明显低于常规治疗组（P＜0.05）。另外，PCT组患者抗菌疗程较常规治疗组明显缩短（P<0.01）。结论 在老年AECOPD患者治疗中根据PCT水平使用抗生素可以达到有效治疗效果，可避免过度使用抗菌药物，缩短住院时间，同时降低住院费用及抗菌药物费用。

Abstract:

Objective To evaluate the clinical value of monitoring the level of procalcitonin (PCT) in the elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with bacterial infection. Methods A total of 140 elderly patients with AECOPD admitted in our hospital from July 2012 to January 2013 were enrolled in this study. They were randomly divided into the PCT guidance group (n=72) and the routine therapy group (n=68). On the basis of similar routine treatment, the patients of the PCT guidance group were treated with antibiotics according to their serum PCT level. While, for those in the routine therapy group, antibiotics were administered according to the physician’s clinical experiences combined with patient’s conditions. The duration of antibiotic therapy, clinical efficacy, costs of hospitalization and antibiotics, length of hospital stay, and inflammatory indices after antibiotic therapy［total white blood cell count (WBC) and C-reactive protein (CRP)］ were compared between the two groups. Results There were no significant differences in the WBC count and CRP level between the 2 groups (P>0.05), but the PCT guidance group had obviously shorter length of hospital stay (P<0.01), and lower costs of hospitalization and antibiotics when compared with the routine therapy group (P<0.05). In addition, the PCT guidance group had obviously shorter duration of antibiotic therapy, when compared with the routine therapy group (P<0.01). Conclusion Using PCT level to guide the antibiotic treatment strategies will improve the efficacy of the antibiotics, avoid the unnecessary antibiotic exposure, shorten length of hospital stay and lower the costs of hospitalization and antibiotics in the treatment of the elderly patients with AECOPD.