摘要
目的探讨系列监测血清降钙素原(procalcitonin,PCT)在指导肺部感染治疗效果评价中的作用。方法前瞻性单中心观察研究,我院ICU中需要机械通气的肺部感染患者在24 h内入选。分别在24、72 h,第7天和治疗结束时测定血清PCT。按《抗菌药物临床研究指导原则》评价疗效并分为有效组(n=48)与失败组(n=25),比较两组间PCT的变化规律。结果 73例患者入选,平均年龄(60.7±19.8)岁。治疗后72 h早期疗效评估时,两组PCT变化率分别为(34.1±14.6)%和(13.7±6.5)%,差异有统计学意义(P=0.009),而PCT值分别为(2.25±0.95)μg/L和(3.59±1.17)μg/L(P=0.045)。就预测疗效的单一指标而言,72 h PCT变化率的受试者工作曲线下面积(AUC)为0.811(P=0.002),优于临床肺感染评分(CPIS)(AUC=0.688)、PCT值、体温及白细胞计数(P均>0.05)。72 h的PCT变化率(下降>31.7%)联合CPIS(<6分)的AUC为0.931,灵敏度为83.8%,特异度为91.7%。结论系列监测PCT有助于指导肺部感染治疗效果评价,特别是72 hPCT变化率能早期预测疗效,联合CPIS可进一步提高其预测价值。
Objective This study aimed to determine if serial measurements of procalcitonin （PCT） could inform the efficacy evaluation in patients with pneumonia. Methods A prospective, single center, observational study was conducted in eligible patients with severe pneumonia in ICU. PCT samples were collected at baseline, 72 hours, 7 clays and end of therapy. Patients were divided into responder group （n = 48） and nonresponder group （n = 25）. Results Seventy-three patients were evaluable. The mean age was 60.7 ± 19.8 years. The change of PCT within the first 72 hours （ΔPCTm %） was significantly different between the two groups （34.1% ± 14.6% vs 13.7% ± 6.5%, P=0.009）. The PCT level was （2.25±0.95） μg/Land （3.59 ± 1.17） μg/L respectively （P = 0. 045）. The area under the curve （AUC） of ΔPCTD3 % for predicting clinical efficacy was 0. 811 （P= 0. 002）, better than Clinical Pulmonary Infection Score （CPIS） （AUC= 0. 688）, PCT level, white blood cell count and body temperature （P〉0.05）. Especially, the ΔPCTD3 % （cut-off 〉31. 7%） in combination with CPIS （〈6） was associated with the best performance to predict clinical efficacy with a AUC of 0. 931, sensitivity of 83.8% and specificity of 91.7%. Conclusions Serial measurements of PCT can reflect the treatment response of antimicrobial therapy. Especially, the ΔPCTD3 % plus CPIS can improve the prediction of treatment effect for pneumonia at early stage.
出处
《中国感染与化疗杂志》
CAS
北大核心
2013年第3期190-194,共5页
Chinese Journal of Infection and Chemotherapy
关键词
降钙素原
肺部感染
疗效评价
procalcitonin
pulmonary infection
efficacy evaluation
