李晓宁，周　超，魏　丽，王　岸



.临床论著.

监测降钙素原水平指导AECOPD患者抗感染治疗的临床研究

李晓宁，周超，魏丽，王岸

目的探讨监测慢性阻塞性肺疾病（COPD）急性加重期(AECOPD)患者血清降钙素原（PCT）水平对指导临床抗感染治疗的价值。方法将我院收治的AECOPD患者136例随机分为，实验组67例，对照组69例。实验组动态监测PCT水平，并据此指导临床治疗；对照组按常规经验性治疗。随访1年，比较两组患者首次再发AECOPD时间、发生频率、每次平均住院时间、因加重转入ICU治疗的比例、病死率等指标。结果实验组PCT水平在治疗好转后明显下降。实验组再发AECOPD时间较对照组明显延长(5.17±0.87)vs(4.39±0.65)个月，发生频率(2.31±0.34)vs(2.86±0.46)例次、每次平均住院时间(14.73±4.67)vs (16.89±5.42)d均显著低于对照组（P＜0.05）。实验组和对照组分别有5例次和14例次因COPD急性加重而转入ICU病房，差异具有统计学意义(P＜0.05)。两组病死率无统计学差异。结论监测PCT水平有利于早期预测COPD患者发生感染急性加重风险，指导临床更有效地抗感染治疗。

慢性阻塞性肺疾病；急性加重期；降钙素原；抗感染；治疗

[Abstract]Objective To investigate the guidance value of procalcitonin(PCT)levels in the anti-infective therapy on patients with acute exacerbation of COPD.Methods 136 patientswith ACOPD were randomly divided into experimental group(67 cases)and control group(69 cases).PCT levels in the experimental group were dynamically monitored in order to provide guidance for the clinic. The control group received routine empiric therapy.The follow-up wasmade for 1 year.Comparison wasmade in the time to the first recurrence,frequency of recurrence,average stay,ICU ratio,and mortality rate between the two groups.Results PCT levels in the experimental group significantly decreased after the improvement by treatment.Compared with the time to the first recurrence in the control group,that in the experimental group significantly prolonged(5.17±0.87)vs(4.39±0.65)months.Its frequency of recurrence (2.31±0.34)vs(2.86±0.46)times,and average stay(14.73±4.67)vs(16.89±5.42)d were all significantly lower than those of the control group(P＜0.05).There were 5 and 14 cases turning to ICU because of the acute exacerbation in the experimental and the control group,respectively,and the difference was significant(P＜0.05).However,there was no significant difference in the case fatality rate. Conclusion Monitoring PCT levels is helpful to the early prediction of infection risk in patients with COPD,which can provide guidance for themore effective anti-infective therapy in the clinic.

[Keywords]chronic obstructive pulmonary disease;acute exacerbation;procalcitonin;anti-infection;treatment

慢性阻塞性肺疾病（COPD）是临床常见的严重危害健康的呼吸道疾病，发生急性加重是导致患者疾病迅速进展甚至死亡的重要原因，而早期预防再发并及时治疗，可能改善患者呼吸道症状的恶化、延缓疾病的进展[1]。但是目前临床还没有用于COPD急性加重期(AECOPD)的诊断和评估的敏感指标。AECOPD诱因多为细菌感染，40%～60%的患者痰液中可以分离出细菌[1]，越来越多的研究证明，降钙素原（PCT）水平在严重细菌感染时明显升高[2-4]。……