标题：血清降钙素原联合C反应蛋白检测在老年肺炎抗菌治疗中的应用

      作者：胡国新，谭荣任，翟瑞玲，王萍，郑衍昌，马长注，陈银花，何银欢
    (肇庆市高要区中医院内科，广东 肇庆 526100)

      卷次： 2016年27卷14期

      【摘要】 目的 观察血清降钙素原(PCT)联合C反应蛋白(CRP)检测指导老年肺炎患者抗菌治疗的临床效
果。方法 选取我院内科2015年1~12月收治的186例老年肺炎住院患者，按随机数表法分为对照组和观察组，每
组各 93例。对照组根据医生临床经验决定抗菌素的使用，观察组则根据 PCT及CRP监测情况决定抗菌药物使
用。比较两组患者的临床治疗效果及不良事件发生情况。结果 观察组患者的肺部啰音消失时间、影像学转阴时
间和痰培养转阴时间分别为(5.1±1.1) d、(6.3±1.4) d和(6.5±1.4) d，均明显少于对照组的(10.6±2.4) d、(12.5±2.5) d、
(12.7±2.6) d，差异均有统计学意义(P<0.05)；观察组患者的白细胞计数、C反应蛋白含量和 PCT含量分别为(6.5±
1.2)×109/L、(0.415±0.024) ng/mL和(5.482±1.032) ng/mL，均明显优于对照组的(7.2±1.4)×109/L、(0.542±0.035) ng/mL
和(6.812±1.248) ng/mL，差异均有统计学意义(P<0.05)；观察组患者的抗生素使用时间、住院时间和住院经费分别为
(7.1±1.2) d、(9.1±3.2) d和(6 575.4±240.6)元，均明显少于对照组的(11.8±2.2) d、(13.8±4.1) d、(10 426.5±312.4)元，差
异均有统计学意义(P<0.05)；观察组患者细菌耐药 1例、菌群失调 0例、二重感染 1例，对照组分别为 8例、7例、10
例，观察组患者总不良事件发生率为2.2%，低于对照组的26.9%，差异有统计学意义(P<0.05)。结论 降钙素原联
合C反应蛋白指导老年肺炎患者抗菌治疗可显著提高治疗效果，减少抗生素使用时间、住院时间及住院经费，值得
临床推广应用。

      【关键词】 降钙素原；C反应蛋白；老年肺炎；抗菌治疗；疗效

      【中图分类号】 R563.1 【文献标识码】 A 【文章编号】 1003—6350（2016）14—2263—03


Application of serum procalcitonin combined with C-reactive protein detection in antibacterial treatment of
elderly patients with pneumonia.
HU Guo-xin, TAN Rong-ren, ZHAI Rui-ling, WANG Ping, ZHENG Yan-chang, MA
Chang-zhu, CHEN Yin-hua, HE Yin-huan. Department of Internal Medicine, Traditional Chinese Medicine Hospital of
Zhaoqing City, Zhaoqing 526100, Guangdong, CHINA

【Abstract】 Objective To observe the clinical effect of serum procalcitonin combined with C-reactive protein
detection for guiding the antibacterial therapy in elderly patients with pneumonia. Methods A total of 186 elderly pa-
tients with pneumonia in our hospital from January 2015 to September 2015 were selected and randomly divided into con-
trol group and observation group based on the random number table, with 93 patients in each group. The control group ac-
cording to the doctor clinical experience decided to stop using antibacterial treatment, and the observation group according
to the monitored of PCT and CRP level applied antibacterial drugs. The clinical therapeutic effect and adverse events were
compared between the two groups. Results The lung sound disappear time, turn and imaging time and sputum culture
turn time of observation group were significantly earlier than those of control group [(5.1±1.1) d vs (10.6±2.4) d, (6.3±1.4) d
vs (12.5±2.5) d, (6.5±1.4) d vs (12.7±2.6) d, P<0.05]. The white blood cell count, C-reactive protein content and PCT lev-
els of observation group were significantly better than those of the control group [(6.5±1.2)×109/L vs (7.2±1.4)×109/L,
(0.415±0.024) ng/mL vs (0.542±0.035) ng/mL, (5.482±1.032) ng/mL vs (6.812±1.248) ng/mL, P<0.05]. The antibiotic use
time, length of hospital stay and hospitalization expenses in observation group were significantly less than those in the
control group [(7.1±1.2) d vs (11.8±2.2) d, (9.1±3.2) d vs (13.8±4.1) d, (6 575.4±240.6) yuan vs (10 426.5±312.4) yuan,
P<0.05]. In the observation group, there were 1 case of bacterial drug resistance, 0 case of dysbacteriosis, 1 case of dou-
ble infection in the obserration group and 8 cases, 7 cases, 10 cases in the control group. The incidence of adverse event
was significantly lower than control group (2.2% vs 26.9%, P<0.05). Conclusion Procalcitonin combined with C-reac-
tive protein detection for guiding the antibacterial therapy in elderly patients with pneumonia can significantly improve
the treatment effect, and reduce the use of antibiotics, hospitalization time and hospitalization expenses. It is worthy to
be clinically popularized and applied.

      【Key words】 Procalcitonin (PCT); C-reactive protein (CRP); Senile pneumonia; Anti-bacterial treatment; Effect
·论 著·
6350.2016.14.010