降钙素原测定对危重支气管哮喘急性发作抗生素使用的指导作用  

Procalcitonin Guidance of Antibiotic Therapy in Acute Exacerbations of Severe Asthma

作　　者：龙威[1] 邓星奇 张学敏[3] 谢娟[3] 杨敬业[1] 钟远[1] 

机构地区：[1]上海交通大学附属上海市第六人民医院老年病科,上海200233 [2]闵行区中心医院急诊科,上海201100 [3]复旦大学附属上海市第五人民医院急诊科,上海200240

出　　处：《中国呼吸与危重监护杂志》2012年第5期444-447,共4页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的研究血清降钙素原(PCT)检测在危重支气管哮喘急性发作患者对使用抗生素的指导作用。方法选取2008年4月至2010年12月间收治的危重哮喘急性加重患者77例,随机分配到两组:PCT指导治疗组38例(PCT组)和常规治疗组39例(对照组),检测血清PCT水平。在相同常规治疗基础上,对照组由经治医师按照抗生素使用指南决定抗生素疗程,PCT组按照血清PCT水平决定何时停用抗生素,在血清PCT≥0.25 ng/mL时,进行抗生素治疗,PCT<0.25 ng/mL时,停止抗生素治疗。观察两组患者的抗生素疗程,抗生素费用及住院时间。结果 PCT组抗生素疗程[7(5～11)d]短于对照组[11(7～16)d](Z值=-2.26,P=0.025),抗生素费用[2125(1560～4347)元]低于对照组[3588(2677～5280)元](Z值=-2.01,P=0.033),两组的住院时间及预后无明显差异。结论危重支气管哮喘急性发作患者根据PCT使用抗生素,能够缩短抗生素疗程,减少抗生素费用。Objective To investigate the value of proealcitonin-guided treatment on antibiotic use in severe acute exacerbations of asthma. Methods From April 2008 to December 2010, a total of 77 patients with severe acute exacerbations of asthma were randomly assigned into a PCT group （ n = 38 ） and a control group （n = 39 ）. The serum concentration of procalcitonin （PCT） were measured in all patients. On the base of similar routine treatment,the control group received antibiotics based on the physician＇ s decision. Meanwhile the PCT group were treated with antibiotics according to serum PCT levels：antibiotic treatment was applied with PCT level ≥0.25ng/mL and was diseontinoued with PCT level 〈 0.25ng/mL. Length of hospitalization, duration of antibiotics, cost of antibiotics, clinical efficacy were observed. Results The duration of antibiotics use in the PCT group [ 7 （5 - 11 ） d ] was shorter than that in the control group [ 11 （7 - 16） d ] （ Z = - 2. 26, P = 0. 025 ）, and the cost of antibiotics in the PCT group [ ￥ 2125 （ 1560 - 4347）yuan] was lower than that in the control group [ ￥3588 （2677 ~ 5280）yuan ] （Z = -2.01 P = 0. 033）. The clinical efficacy and length of hospitalization were similar in two groups （P 〉 0. 05 ）. Conclusion PCT guidance can reduce antibiotic duration and antibiotic cost in treatment of acute severe exacerbations of asthma.

关 键 词：支气管哮喘 降钙素原 抗生素 

分 类 号：R562.25[医药卫生—呼吸系统]