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目的探讨血清降钙素原(PCT)在儿童重症细菌感染抗生素降阶梯治疗中的指导价值。方法将2012年1月至2013年2月在安徽医科大学附属安庆医院收治的243例患儿,分为重症细菌感染组68例,局部细菌感染组63例,非细菌感染组112例。均在入院后24 h内进行PCT、超敏C反应蛋白(hs-CRP)及外周血白细胞计数(WBC)等检查。根据病情轻重、PCT等检查结果,为患儿选用合理的抗生素治疗。比较3组患儿PCT、hs-CRP、WBC的差异。结果重症细菌感染组PCT、hs-CRP、WBC均升高显著;局部细菌感染组PCT、WBC轻度升高,hsCRP升高显著;非细菌感染组三者升高不明显。重症细菌感染组与局部细菌感染组间PCT、hs-CRP、WBC水平P50(P25,P75)比较差异有统计学意义(P<0.05);重症细菌感染组与非细菌感染组间PCT、hs-CRP、WBC水平P50(P25,P75)比较,差异有统计学意义(P<0.05);局部细菌感染组与非细菌感染组间PCT、hs-CRP水平P50(P25,P75)比较差异有统计学意义(P<0.05),WBC水平差异无统计学意义(P>0.05)。结论 PCT水平可作为早期诊断细菌感染、甄别细菌感染轻重的可靠实验室指标;动态监测PCT水平,可及时评估抗生素疗效,对重症细菌感染合理应用抗生素及降阶梯治疗具有较高的指导价值。
Objective To investigate the value of serum procalcitonin (PCT) in the treatment of pediatric severe bacterial infections with antibiotics. Methods A total of 243 children admitted to Anqing Hospital, Anhui Medical University from January 2012 to February 2013 were divided into severe bacterial infection group (68 cases), local bacterial infection group (63 cases) and non-bacterial infection group (112 case). All patients were examined for PCT, hs-CRP and WBC in 24 h after admission. According to the severity, PCT and other test results, the selection of a reasonable antibiotic treatment for children. The differences of PCT, hs-CRP and WBC between the three groups were compared. Results The PCT, hs-CRP and WBC in severe bacterial infection group increased significantly. The PCT and WBC increased slightly in local bacterial infection group, and the hsCRP increased significantly. The non-bacterial infection group had no obvious increase. The levels of PCT, hs-CRP and WBC P50 (P25, P75) between severe bacterial infection group and local bacterial infection group were significantly different (P <0.05); PCT, hs- CRP and WBC levels P50 (P25, P75), the difference was statistically significant (P <0.05). The difference of P50 (P25, P75) between local bacterial infection group and non-bacterial infection group was statistically significant Significance (P <0.05), WBC level difference was not statistically significant (P> 0.05). Conclusions The PCT level can be used as a reliable laboratory index for early diagnosis of bacterial infection and screening for the severity of bacterial infection. Dynamic monitoring of PCT level can evaluate the curative effect of antibiotics in a timely manner and has high guiding value for rational use of antibiotics and step-down therapy in severe bacterial infections.