Wang Hui-Ling, Li Ying-Lei, Li Xiao-Fang, Wang Zhi-Zun
Hui-ling Wang, Department of Neurology, Affiliated Hospital of Hebei University, Baoding, Hebei, 071000, P. R. China.
Ying-lei Li, Department of Emergency, Baoding First Central Hospital, Baoding, Hebei, 071000, P. R. China.
Pak J Med Sci. 2021 Jul-Aug;37(4):1155-1160. doi: 10.12669/pjms.37.4.3932.
To investigate the value of dynamic monitoring of serum procalcitonin (PCT) in anti-infective therapy of patients with acute stroke.
This is a case control retrospective study of acute stroke patients conducted from July 2016 to October 2018, in the Department of Neurology, Affiliated Hospital of Hebei University, who who reached within twenty four hours. They, were selected as the study subjects who were divided into infection group and non-infection group according to the inclusion and exclusion criteria. The serum PCT and CRP levels were compared between the two groups at 24 hours, 48 hours and 72 hours. In order to judge the changes of PCT level and the infection of stroke patients, different kinds of antibiotics were used for corresponding treatment. Retrospective analysis of the cases that did not monitor PCT anti infective treatment before July 2016 were compared with the cases that monitored PCT to guide anti infective treatment after July 2016, and compared the efficacy of antibiotics.
The serum PCT level of patients in the infection group was significantly higher than that of patients in the noninfection group (P<0.001). For the patients whose PCT<0.5 ng/ml within 72 hour, anti-infective therapy was not administered. However, for those patients whose PCT<0.5 ng/ml and CRP rose significantly, WBC, body temperature and chest CT were closely monitored. For the patients whose PCT increased slightly (0.5 ng/ml<PCT<2.0 ng/ml), first-generation and second-generation cephalosporin or semisynthetic penicillin, such as mezlocillin, were administered. For the patients whose PCT increased moderately (5 ng/ml>PCT>2 ng/ml), mezlocillin/ sulbactam or ceftriaxone/ tazobactam was administered. For patients whose PCT increased significantly (PCT>5 ng/ml), carbapenem antibiotic or a combination of two antibiotics was administered.
Dynamic detection of serum PCT concentration can make accurate judgment on the severity of bacterial infection in patients with acute stroke and guide the rational application of antibiotics.
探讨动态监测血清降钙素原（PCT）在急性脑卒中患者抗感染治疗中的价值。
本研究为病例对照回顾性研究，于2016年7月至2018年10月在河北大学附属医院神经内科选取发病24小时内入院的急性脑卒中患者作为研究对象，根据纳入及排除标准将其分为感染组和非感染组，比较两组患者在24小时、48小时及72小时时血清PCT和CRP水平。为判断PCT水平变化及脑卒中患者感染情况，使用不同种类抗生素进行相应治疗。回顾性分析2016年7月前未监测PCT的抗感染治疗病例与2016年7月后监测PCT指导抗感染治疗的病例，并比较抗生素疗效。
感染组患者血清PCT水平显著高于非感染组患者（P<0.001）。对于72小时内PCT<0.5 ng/ml的患者，不给予抗感染治疗。然而，对于PCT<0.5 ng/ml且CRP显著升高的患者，密切监测白细胞、体温及胸部CT。对于PCT轻度升高（0.5 ng/ml<PCT<2.0 ng/ml）的患者，给予第一代和第二代头孢菌素或半合成青霉素，如美洛西林。对于PCT中度升高（5 ng/ml>PCT>2 ng/ml）的患者，给予美洛西林/舒巴坦或头孢曲松/他唑巴坦。对于PCT显著升高（PCT>5 ng/ml）的患者，给予碳青霉烯类抗生素或两种抗生素联合使用。
动态检测血清PCT浓度可准确判断急性脑卒中患者细菌感染的严重程度，并指导抗生素的合理应用。
