CAJ | 학술논문

目的探讨降钙素原(PCT)在慢性阻塞性肺疾病急性加重期(AECOPD)抗生素治疗中的指导作用. 方法入选72例AECOPD患者.随机分成PCT组(40例)和常规治疗组(32例).PCT组患者根据血清PCT水平决定抗生素的使用和停用,如PCT＜0.25μg/L停用抗生素；常规治疗组患者由主治医师根据临床症状决定抗生素的使用.主要观察指标为抗生素的使用率、抗生素使用时间、住院天数、临床有效率、二重感染、加重以及死亡例数等. 结果 PCT组患者临床治疗有效率82.5％,与常规治疗组75.8％比较,差异无统计学意义(x2=0.217,P=0.641),但是PCT组患者抗生素使用率47.5％,较常规治疗组71.9％明显降低(x2=4.346,P=0.037),抗生素平均使用天数也更短[(6.8±3.3)d与(10.2±3.7)d,t=3.116,P=0.003],PCT组患者住院天数(11.7±5.2)d较常规治疗组患者(20.3±8.7)d更短(t=5.202,P=0.000).两组的二重感染的发生率(2.5％与18.8％,x2=3.657,P=0.056)、加重例数(3例与4例,x2=0.097,P=0.756)、死亡率(2.5％与6.3％,x2 =0.039,P=0.843)差异无统计学意义. 结论 PCT可能是指导AECOPD抗生素使用的一项较合适的指标,能有效降低抗生素的不合理使用,降低二重感染,减少住院时间.
목적 탐토강개소원(PCT)재만성조새성폐질병급성가중기(AECOPD)항생소치료중적지도작용. 방법 입선72례AECOPD환자.수궤분성PCT조(40례)화상규치료조(32례).PCT조환자근거혈청PCT수평결정항생소적사용화정용,여PCT＜0.25μg/L정용항생소；상규치료조환자유주치의사근거림상증상결정항생소적사용.주요관찰지표위항생소적사용솔、항생소사용시간、주원천수、림상유효솔、이중감염、가중이급사망례수등. 결과 PCT조환자림상치료유효솔82.5％,여상규치료조75.8％비교,차이무통계학의의(x2=0.217,P=0.641),단시PCT조환자항생소사용솔47.5％,교상규치료조71.9％명현강저(x2=4.346,P=0.037),항생소평균사용천수야경단[(6.8±3.3)d여(10.2±3.7)d,t=3.116,P=0.003],PCT조환자주원천수(11.7±5.2)d교상규치료조환자(20.3±8.7)d경단(t=5.202,P=0.000).량조적이중감염적발생솔(2.5％여18.8％,x2=3.657,P=0.056)、가중례수(3례여4례,x2=0.097,P=0.756)、사망솔(2.5％여6.3％,x2 =0.039,P=0.843)차이무통계학의의. 결론 PCT가능시지도AECOPD항생소사용적일항교합괄적지표,능유효강저항생소적불합리사용,강저이중감염,감소주원시간.
Objective To explore the guiding role of serum procalcitonin (PCT) in antibiotic therapy during acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods Totally 72 patients with AECOPD were randomly divided into PCT group (n=40) and conventional therapy group(n=32).For patients in PCT group,the use of antibiotics was based on PCT serum levels,antibiotics were stopped when PCT＜0.25 μg/L,while in conventional treatment group,the use of antibiotics was based on clinical symptoms of patients.The main observation indexes included ratio of antibiotic usage,time of antibiotics use,hospital stay,clinical efficacy,aggravating cases and death cases. Results There were no significant difference in clinical efficacy between the two groups(82.5％ vs.75.8％,x2 =0.217,P=0.641),however,the ratio of antibiotics usage in PCT patients was significantly lower than conventional therapy group (47.5％ vs.71.9％,x2 =4.346,P=0.037),average time of antibiotics use and days of hospital stay were shorter in PCT treatment group than conventional therapy group [(6.84±3.27) d vs.(10.22±3.67)d,x2 =3.116,P=0.003; (11.7±5.2) d vs.(20.3±8.7) d,x2 =5.202,P=0.000].There were no difference in double infection incidence (2.5％ vs.18.8％,x2 =3.657,P=0.056),aggravating cases (3 cases vs.4 cases,x2 =0.097,P=0.756) and mortality (2.5％ vs.6.3％,x2 =0.039,P=0.843) between the two groups.Conclusions Serum PCT level may be an appropriate indicator to guide antibiotic therapy in patients with AECOPD in view of its effective decreases of excessive use of antibiotics,double infection opportunities and hospitalization time.