血清降钙素原指导AECOPD患者抗菌治疗疗效及预后的meta分析  

Efficacy and prognosis of guiding antibacterial therapy in patients with acute exacerbation of chronic obstructive pulmonary disease by dynamically monitoring PCT levels:a meta-analysis

作　　者：吴新宇 宋丹丹[1] 赵洪文[1] Wu Xinyu;Song Dandan;Zhao Hongwen(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of China Medical University,Shenyang 110001,China)

机构地区：[1]中国医科大学附属一院呼吸与危重症医学科,沈阳110001

出　　处：《国际呼吸杂志》2022年第4期250-261,共12页International Journal of Respiration

基　　金：国家重点研发计划(2016YFC1304301、2016YFC1304303)。

摘　　要：目的系统评价血清降钙素原(PCT)在指导慢性阻塞性肺疾病急性加重(AECOPD)患者抗菌治疗的临床意义。方法通过计算机检索Cochrane、Pubmed、Embase、万方、中国学术期刊全文数据库以及维普中英文数据库,并手工检索有关文献,查阅与监测PCT指导AECOPD患者抗菌治疗相关的国内外文献,检索时限从数据库起始到2020年12月终止。依据筛选标准,选取合格的文献,采用Review Manager 5.3软件分析PCT在指导AECOPD患者抗菌治疗中的临床价值。结果共检索中英文文献950篇,依照筛选标准分析,最终纳入31篇文献,其中包括PCT指导治疗组2892例,传统治疗对照组2885例。结果显示,PCT指导治疗组在病死率、再次急性发作入院率、全因再入院率、入住重症监护病房率等方面与传统治疗对照组比较,差异均无统计学意义(P值均>0.05)。PCT指导治疗组在减少抗菌药物的暴露、二重感染率和住院费用方面,提高临床有效率以及缩短抗菌药物使用疗程和住院时间等方面与传统治疗对照组比较具有优势。结论通过动态监测PCT水平指导AECOPD患者抗菌治疗可减少患者的抗菌药物暴露、提高治疗效果、加快患者康复速度和减轻患者的经济负担,但对患者的预后没有影响。Objective To systematically evaluate the clinical significance of procalcitonin(PCT)in guiding antibacterial therapy in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods Cochrane,Pubmed,Embase,Wanfang,Chinese Academic Journal Full-text Database,and VIP Chinese and English database were searched by computer,and the relevant literatures were searched manually.Domestic and foreign literatures related to monitoring PCT for antimicrobial therapy in patients with AECOPD were reviewed.The retrieval period starts with the database and ends in December 2020.According to the screening criteria,qualified literatures were selected and Review Manager 5.3 software was used to analyze the clinical value of PCT in guiding antibacterial therapy for AECOPD patients.Results A total of 950 Chinese and English literatures were retrieved,with 31 literatures of them included according to the screening criteria,including 2892 subjects in the PCT-guided treatment group and 2885 subjects in the traditional treatment group.The results showed that there was no difference in mortality rate,hospital re-admission rate for AECOPD,hospital re-admission rate for any case,and intensive care unit admission rate between the PCT-guided treatment group and the traditional treatment control group(all P>0.05).However,the PCT-guided treatment group was better than the traditional treatment control group in reducing antibiotic exposure,double infection rate,and hospitalization cost,in increasing clinical success rate,and in shortening the length of treatment and hospitalization admission.Conclusions Guiding AECOPD patients with antimicrobial therapy through dynamic monitoring of PCT level can reduce patients′antimicrobial exposure,improve treatment effect,speed up patients′recovery,and reduce patients′economic burden,but has no effect on patients′prognosis.

关 键 词：肺疾病 慢性阻塞性 急性加重 预后 降钙素原 疗效 

分 类 号：R563.9[医药卫生—呼吸系统]