血清降钙素原在指导抗生素治疗儿童下呼吸道感染中的价值

Value of serum procalcitonin for the guidance of antibiotic therapy in children with lower respiratory tract infection

摘要:

目的评估血清降钙素原(PCT)在指导下呼吸道感染(LRTI)患儿抗生素使用中的价值。方法采用前瞻性随机病例对照研究,选取潍坊市妇幼保健院就诊的LRTI患儿396例,随机分为血清PCT指导抗生素治疗组(PCT组)和临床指导标准治疗组(对照组)。并按照是否为社区获得性肺炎(CAP)进行亚组分析。治疗后观察14 d,比较组间抗生素的使用率、抗生素使用时间、不良反应发生情况等。结果 PCT组和对照组分别入选198例患儿,两组中CAP患儿分别为125例和123例。PCT组抗生素使用时间显著低于对照组(P<0.05)。亚组分析显示,PCT指导治疗的CAP和非CAP亚组患儿的抗生素使用时间均明显低于对照组(P<0.05);但PCT指导治疗的非CAP亚组患儿抗生素使用率显著高于对照组(P<0.05)。PCT组和对照组两组患儿抗生素治疗的不良反应发生率和不良反应持续时间、住院率和住院时间以及安全性差异无统计学意义。结论应用血清PCT指导LRTI患儿抗生素的使用可缩短抗生素使用时间。

Abstract:

Objective To evaluate the value of serum procalcitonin (PCT) for the guidance of antibiotic therapy in children with lower respiratory tract infection (LRTI). Methods A prospective randomized controlled study was conducted in 396 children with LRTI who visited Weifang Maternity and Child Care Hospital. The participants were randomly assigned into a PCT group in which the antibiotic therapy was guided by serum PCT level and a control group in which the standard therapy was given according to clinical guidance. Afterwards, a subgroup analysis was performed according to whether the patient was diagnosed with community-acquired pneumonia (CAP). After 14-day treatment, antibiotic prescription rate, duration of antibiotic treatment, and side events were compared between the groups. Results A total of 396 cases were recruited and equally assigned into the PCT group and the control group, among whom the numbers of the children with CAP were 125 and 123, respectively. The mean duration of antibiotic treatment was significantly shorter in the PCT group than in the control group (P<0.05). The subgroup analysis showed that the duration of antibiotic treatment in both CAP and non-CAP PCT subgroups was significantly shorter than in the control subgroups (P<0.05), however, the antibiotic prescription rate in the non-CAP PCT subgroup was significantly higher than that in the non-CAP control subgroup (P<0.05). There were no differences in the rate and duration of side events from antibiotic therapy, hospitalization rate, the length of hospital stay, and safety between the PCT and control groups. Conclusions Serum PCT-based guidelines on antibiotic use can shorten the duration of antibiotic therapy in children with LRTI.