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目的研究感染性慢性阻塞性肺疾病(简称慢阻肺)急性加重期患者接受常规疗程的静脉抗生素治疗后降钙素原(PCT)水平是否能够预测未来急性加重的风险,同时观察附加疗程的口服抗生素治疗是否能够降低急性加重风险。方法纳入2012年10月至2013年10月于华西医院住院治疗的感染性慢阻肺急性加重患者为研究对象,收集停用末次静脉抗生素时血清PCT值、C反应蛋白(CRP)值、白细胞计数及中性粒细胞比例,查看患者出院医嘱是否带口服抗生素,定期随访,随访期1年,记录患者首次急性加重的时间和加重的次数。采用Cox风险回归模型分析危险因素。结果总共纳入138例患者。Cox风险回归模型分析结果显示,不同水平的PCT值(HR=1.462,P=0.035)和中性粒细胞比例(HR=1.673,P=0.005)与慢阻肺急性期后再次发生急性加重有显著相关性,CRP值(P=0.330)、白细胞计数(P=0.432)和口服抗生素(P=0.231)与急性加重无相关性。PCT水平较高时患者口服抗生素治疗能够降低急性加重风险(HR=2.29,P=0.004)。结论血清PCT水平和中性粒细胞比例能够预测未来急性加重的风险,高水平PCT患者附加口服抗生素治疗有利于降低复发风险。
Objective To investigate whether the level of procalcitonin (PCT) after routine treatment with intravenous antibiotics in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) can predict the risk of acute exacerbation in the future and to observe the additional course of oral administration Can antibiotic treatment reduce the risk of exacerbations? Methods The patients with acute COPD admitted to West China Hospital from October 2012 to October 2013 were enrolled in this study. Serum PCT, C-reactive protein (CRP), white blood cell count And the proportion of neutrophils to see if the patient discharged from the doctor’s advice with oral antibiotics, regular follow-up of 1 year, recording the first time the patient exacerbated the time and the number of exacerbations. Risk factors were analyzed using a Cox risk regression model. Results A total of 138 patients were enrolled. The results of Cox risk regression model showed that the acute exacerbations were significant at different levels of PCT (HR = 1.462, P = 0.035) and neutrophil ratio (HR = 1.673, P = 0.005) Correlation, CRP (P = 0.330), white blood cell count (P = 0.432), and oral antibiotics (P = 0.231) were not associated with acute exacerbations. Oral antibiotic therapy reduced the risk of exacerbations (HR = 2.29, P = 0.004) at higher PCT levels. Conclusions Serum PCT level and neutrophil ratio can predict the risk of acute exacerbation in the future. High-level oral antibiotic treatment of PCT patients is helpful to reduce the risk of relapse.