降钙素原联合标准方法指导儿童社区获得性肺炎抗菌药物治疗的临床价值  

Procalcitonin combined with standard therapy for guiding antibiotic therapy in children with community acquired pneumonia

作　　者：许蔓春[1] 马恒颢[1] 廖扬[2] 任广立[1] 曹姝平[1] 王鲜艳[1] 石玉玲[2] 

机构地区：[1]广州军区广州总医院小儿科,广州510010 [2]广州军区广州总医院检验科,广州510010

出　　处：《检验医学与临床》2014年第5期623-625,共3页Laboratory Medicine and Clinic

摘　　要：目的评价降钙素原(PCT)联合标准方法在指导儿童社区获得性肺炎(CAP)抗菌药物治疗中的价值。方法对190例可疑合并细菌感染的小儿非重症病毒性肺炎进行回顾性分析。分为联合方法组和标准治疗组,联合方法组为101例,按PCT浓度监测联合我国目前儿童CAP管理指南的方法指导使用抗菌药物,当P CT<0.25μg/L且临床可疑细菌感染及PCT>0.25μg/L者均使用抗菌药物;当PCT小于0.25μg/L且临床无伴细菌感染者予停药。标准治疗组89例,单独按CAP指南标准使用抗菌药物。两组均至少使用抗菌药物3d后再次评估。最终分析抗菌药物的使用情况及临床疗效。结果与标准治疗组比较,联合方法组抗菌药物处方使用率明显降低[(4.9±1.4)d vs.(6.8±2.8)d],并且其抗菌药物使用时间及抗菌药物不良反应发生率也更少(2.0%vs.20.0%),以上两组各指标比较差异均有统计学意义(P<0.05)。两组住院时间及呼吸道症状复发率差异均无统计学意义(P>0.05)。结论 PCT联合标准方法能明显减少儿童CAP抗菌药物的使用而未影响临床疗效,有助于更加合理使用抗菌药物。Objective To evaluate procalcitonin（PCT） measurement combined with standard therapy in guid-ing antibiotic therapy in children with community acquired pneumonia （CAP） .Methods The datas of 190 hospitalized children with uncomplicated CAP diagnosed as viral infection and suspected bacterial infection were retrospectively collected and analyzed .Among them ,101 patients belonged to combined method group ,who initiated antibiotics on basis of PCT concentration and current guidelines for the management of CAP in Chinese children .Antibiotics was recommended to be used when PCT ＆lt;0 .25 μg/L but suspected bacterial infections in clinic or PTC ≥0 .25 μg/L ,u-sing of antibiotics was discouraged while PTC＆lt;0 .25 μg/L and no infection .Other 89 patients belonged to standard therapy group received antibiotics according to current guidelines alone .Reevaluation was did after antibiotic therapy at least three days in both groups .The use of antibiotics and clinical outcome was analyzed at last .Results Compared with standard group ,the combined method group received significantly fewer antibiotic prescriptions （P＆lt;0 .05） ,were exposed to antibiotics for a shorter time[（4 .9 ＆#177; 1 .4） vs （6 .8 ＆#177; 2 .8）] ,and experienced fewer antibiotic associated ad-verse effects（2 .0% vs 20 .0% ,P＆lt;0 .05） .There was no significant differences between groups in length of hospitali-zation and the proportion of children with recurrent infection symptoms requiring antibiotic treatment （P＆gt; 0 .05） . Conclusion The combined approach for children with CAP can markedly reduced antibiotic use without compromi-sing efficacy ,which contribute to the rational use of antibiotics .

关 键 词：降钙素原 儿童 社区获得性肺炎 抗菌药物 

分 类 号：R969.3[医药卫生—药理学]