Division of Gastroenterology and Hepatology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong.
Eur J Gastroenterol Hepatol. 2014 Feb;26(2):179-86. doi: 10.1097/MEG.0b013e328365a3b7.
Protocols for antibiotic treatment of pyogenic liver abscess (PLA) are usually based on clinicians' own experience without any validation. Our study was to evaluate the clinical implication of C-reactive protein (CRP) in predicting treatment outcome and adequacy of antibiotic therapy of PLA.
Patients with PLA in whom white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and CRP were checked regularly during the clinical course were included. The prolife of CRP during the clinical course was compared with that of ESR and WBC. The usefulness of CRP in predicting the chance of recovery and adequacy of antibiotic therapy was examined.
From 2000 to 2011, 109 patients with PLA underwent regular monitoring of WBC, ESR, and CRP. Except for ESR, both WBC and CRP showed an initial rapid reduction in first 3 weeks, followed by a relatively slow decrease. From week 3 to week 6, the CRP ratio (relative to CRP at week 1) of patients with and without adverse events (i.e. including mortality) was compared; a significant difference was found at week 3 (P=0.001), week 4 (P=0.004), week 5 (P=0.011), and week 6 (P=0.018), whereas no statistically significant difference was found in the WBC ratio over the same period. By week 3, a CRP ratio of 0.423 or less was a marker of good outcome (sensitivity 0.846; specificity 0.667) and was also a marker of adequacy of antibiotic therapy of 5 weeks or less (sensitivity 0.786; specificity 0.714) if the ratio was 0.278 or less.
Weekly CRP measurement was useful in the identification of patients with PLA with good outcome and adequacy of antibiotic therapy of 5 weeks or less.
化脓性肝脓肿（PLA）的抗生素治疗方案通常基于临床医生的经验，而没有任何验证。我们的研究旨在评估 C 反应蛋白（CRP）在预测 PLA 治疗结果和抗生素治疗充分性方面的临床意义。
纳入在临床病程中定期检查白细胞计数（WBC）、红细胞沉降率（ESR）和 CRP 的 PLA 患者。比较 CRP 在临床病程中的增殖与 ESR 和 WBC 的增殖。检查 CRP 在预测恢复机会和抗生素治疗充分性方面的有用性。
2000 年至 2011 年，109 例 PLA 患者接受了 WBC、ESR 和 CRP 的定期监测。除了 ESR，WBC 和 CRP 在前 3 周均迅速下降，随后下降速度相对较慢。从第 3 周到第 6 周，比较有无不良事件（即包括死亡率）的患者的 CRP 比值（与第 1 周的 CRP 比值）；第 3 周（P=0.001）、第 4 周（P=0.004）、第 5 周（P=0.011）和第 6 周（P=0.018）有显著差异，而同期 WBC 比值无统计学差异。到第 3 周，CRP 比值<0.423 是良好预后的标志物（敏感性 0.846；特异性 0.667），如果比值<0.278，则也是 5 周或更短时间内抗生素治疗充分的标志物（敏感性 0.786；特异性 0.714）。
每周 CRP 测量有助于识别 PLA 患者预后良好和抗生素治疗 5 周或更短时间内的患者。
