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目的研究胎膜早破患者外周血降钙素原(procalcitonin,PCT)水平,以了解细菌感染情况和指导抗生素治疗。方法选取龙华新区人民医院2012年12月至2015年1月收治的118例孕35~41周胎膜早破(premature rupture of membranes,PROM)孕妇作为观察组,同期孕检的40名健康孕妇作为对照组。采用电化学发光法(electrochemical luminescence,ECLIA)测定血清PCT,结合白细胞计数和胎盘病理检查,比较各组PCT水平和感染情况及使用抗生素时间。将观察组患者按照PCT水平分为A组38例(<0.25 ng/m L)、B组45例(0.25~0.50 ng/m L)、C组35例(>0.50 ng/m L)。结果对照组PCT均值为(0.14±0.06)ng/m L,A、B、C 3组均值分别为(0.17±0.09)ng/m L、(0.35±0.10)ng/m L和(4.34±3.35)ng/m L。A组血清PCT水平与对照组比较差异无统计学意义(t=0.520,P>0.05);B组较A组PCT水平升高(t=4.187,P<0.01),C组较B组PCT水平升高(t=4.996,P<0.01)。经抗生素治疗1 d后,A组治疗前后PCT水平比较差异无统计学意义(t=0.730,P>0.05),B组治疗后较治疗前有下降趋势,但差异无统计学意义(t=2.357,P>0.05),C组治疗前后比较,差异有统计学意义(t=3.598,P<0.05);出院前比较,各组间PCT水平差异均无统计学意义(P>0.05)。但以血清PCT 0.50 ng/m L为基线,PCT>0.5 ng/m L为阳性,PROM患者组织学绒毛膜羊膜炎检查比较,3组间差异有统计学意义(P<0.05)。通过动态监测PCT水平,A组较B、C两组抗生素使用时间短(t=7.840、10.971,P均<0.01);B组短于C组(t=4.992,P<0.01)。结论血清PCT水平是细菌感染的重要指标,其诊断效率高。本研究中3个等级组有明确的基线界限,分为正常、可疑感染和明确感染,推荐对应治疗分别为不使用抗菌药物、可使用抗菌药物和强烈建议使用抗菌药物。血清PCT检测对胎膜早破患者治疗期间的早期临床诊治、合理用药具有指导意义。
Objective To study the level of procalcitonin (PCT) in the peripheral blood of patients with premature rupture of membranes to understand the bacterial infection and guide the antibiotic treatment. Methods A total of 118 pregnant women with premature rupture of membranes (PROM) from December 2012 to January 2015 admitted to Longhua New District People’s Hospital from December 2012 to January 2015 were enrolled in this study. Forty healthy pregnant women Control group. The serum PCT was detected by electrochemical luminescence (ECLIA), and the white blood cell count and placental pathology were examined. The PCT level, infection and antibiotic time were compared between groups. The patients in the observation group were divided into group A (38 cases, <0.25 ng / m L), group B (45 cases, 0.25-0.50 ng / m L) and group C, 35 cases (> 0.50 ng / m L) Results The mean of PCT in control group was (0.14 ± 0.06) ng / m L and that in group A, B and C were (0.17 ± 0.09) ng / m L, (0.35 ± 0.10) ng / m L and (4.34 ± 3.35 ) ng / m L. The level of PCT in group A was not significantly different from that in control group (t = 0.520, P> 0.05); PCT in group B was higher than that in group A (t = 4.187, P <0.01) Increased (t = 4.996, P <0.01). After treatment with antibiotics for 1 day, there was no significant difference in PCT level between before and after treatment in group A (t = 0.730, P> 0.05), and in group B after treatment was decreased compared with that before treatment, but the difference was not statistically significant (t = 2.357 , P> 0.05). There was significant difference between before and after treatment in group C (t = 3.598, P <0.05). Before discharge, there was no significant difference in PCT between groups (P> 0.05). However, the serum PCT 0.50 ng / m L as the baseline, PCT> 0.5 ng / m L was positive, PROM histological chorioamnionitis examination, the difference between the three groups was statistically significant (P <0.05). By dynamically monitoring the level of PCT, the antibiotic use time in group A was shorter than that in group B and C (t = 7.840, 10.971, P <0.01), while in group B was shorter than that in group C (t = 4.992, P <0.01). Conclusion Serum PCT level is an important index of bacterial infection, and its diagnostic efficiency is high. The three rating groups in this study had a clear baseline cutoff, categorized as normal, suspicious, and definitive infections. The recommended treatments were no antimicrobials, antimicrobials, and antimicrobials. Serum PCT detection of premature rupture of membranes in patients with early clinical diagnosis and treatment, rational drug use is instructive.