Objective To explore the value of serum procalcitonin (PCT) in guiding the severity and antibiotic treatment in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods Sixty-eight elderly AECOPD patients who received treatment in Seventh People's Hospital, Shanghai University of TCM from Oct 2014 to Oct 2015 were divided into two groups, including 34 patients of control group,34 patients of experimental group.Control group was given antibiotic therapy guided by clinical symptoms, white blood cell (WBC) and C reactive protein (CRP).Experimental group received antibiotic therapy according to the level of serum PCT.The changes of the serum PCT, WBC and CRP, blood gas indicators at different time point, prognosis between two groups were compared.Results From 3rd and 7th day after admission, the serum PCT, WBC, CRP in AECOPD patients were all reduced compared with those at admission.The levels of serum PCT and CRP in experimental group were significantly lower than those in control group (F =6.23, F =4.23, P <0.01), while there was no statistically significant difference on the level of WBC at the same time between two groups (F =2.18, P =0.062).From 3rd day after admission, the levels of pH, PaCO2, PaO2, SaO2 were all improved compared with before treatment, and these indicators in experimental group were significantly better than those in control group (F =8.98, F =5.92, F =7.97, F =4.29, P <0.01).Compared with experiential treatment group, the time of hospital stay, time of antibiotics therapy in experimental group was significantly reduced, and the costs of antibiotics also reduced (t =9.33, t =38.04, t =11.95,all P <0.01), recurrence rate and mortality were significantly decreased (χ2=4.66,χ2=3.98, P =0.031, P =0.047).Conclusion Serum PCT dynamic monitoring can guide and optimize the antibiotic treatment strategy, and improve the disease outcome in elderly patients with AECOPD.%目的 分析动态监测血清降钙素原(PCT)对老年慢性阻塞性肺疾病急性加重期(AECOPD)患者病情及抗菌治疗的指导价值.方法 选取2014年10月-2015年10月上海中医药大学附属第七人民医院呼吸科收治的AECOPD患者68例,随机数字表法分为对照组( n =34)和观察组( n =34).对照组以常规临床症状、白细胞(WBC)、C反应蛋白(CRP)等指导抗生素的使用,观察组以血清PCT水平指导抗生素的使用.比较2组不同时点血清PCT、WBC、CRP水平变化、血气指标及转归.结果 入院第3~7天,2组血清PCT、WBC及CRP水平均较入院时显著降低,观察组血清PCT、CRP水平低于对照组(F =6.23、4.23, P <0.01),而WBC水平2组相同时点比较,差异均无统计学意义(F =2.18, P =0.062).入院第3天起,2组血气指标(pH、PaO2、PaCO2、SaO2)显著改善,观察组改善均优于对照组(F =8.98、5.92、7.97、4.29, P <0.01).与对照组比较,观察组住院时间、抗生素的使用时间明显缩短,抗生素费用明显减少 (t =9.33、38.04、11.95, P 均<0.01),复发率、病死率均降低 (χ2=4.66、3.98, P =0.031、0.047).结论 动态监测血清PCT水平可指导和优化老年AECOPD患者抗生素治疗策略,改善疾病转归.
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