目的:系统评价以降钙素原(PCT)指导脓毒症患者抗菌药物应用的效果,探讨PCT作为可靠的炎症标记物用于指导临床合理使用抗菌药物的可能性。方法:计算机检索PubMed、EMBase、Cochrane图书馆、中国期刊全文数据库、万方数据库,收集PCT指导的治疗方案(试验组)对比常规治疗方案(对照组)用于脓毒症的相关试验,提取资料并采用改良Jadad评分法评价质量后,运用Rev Man 5.3统计软件进行Meta分析。结果:共纳入5项研究,合计826例患者。Meta分析结果显示,试验组患者抗菌药物使用时间显著短于对照组,差异有统计学意义[MD=-2.52,95%CI(-3.07,-1.98),P<0.001];两组患者病死率[OR=1.14,95%CI(0.83,1.56),P=0.42]、重症加强护理病房治疗时间[MD=-0.22,95%CI(-1.40,0.96),P=0.72]和总住院时间[MD=-1.81,95%CI(-4.37,0.76),P=0.17]比较,差异无统计学意义。结论:以PCT指导脓毒症患者抗菌药物治疗可以有效减少抗菌药物的应用, 缩短治疗时间。临床可以考虑将其作为炎症标记物用于指导合理使用抗菌药物。
Abstract
OBJECTIVE: To systematically review the procalcitonin(PCT) -guided therapy in patients with sepsis. METHODS: Retrieved from PubMed, Cochrane Library, EMBase, CJFD, Wanfang Datebase, related trails about PCT-guided therapy(test group) versus conventional treatment group (control group) in the treatment of sepsis were collected. Meta-analysis was performed by using Rev Man 5.3 software after data extraction and quality evaluation. RESULTS: Totally 5 studies were enrolled, involving 826 patients. Results of Meta-analysis showed, use time of antibiotics in test group was significantly shorter than control group, with statistical significance [MD=-2.52,95%CI(-3.07,-1.98,P<0.001]; there were no significant differences in the mortality rate [OR=1.14,95%CI(0.83,1.56),P=0.42], ICU treatment days [MD=-0.22,95%CI(-1.40,0.96),P=0.72] and total hospitalization [MD=-1.81,95%CI(-4.37,0.76),P=0.17]. CONCLUSIONS: PCT-guided therapy can effectively reduce the use of antibiotics and shorten treatment time in the treatment of patients with sepsis.It can be considered as inflammatory markers for guiding rational use of antibiotics in clinic.
关键词
严重感染脓毒症降钙素原临床试验随机对照试验Meta分析抗菌药物
Keywords
severe infectionSepsisProcalcitoninClinic testRCTMeta-analysisAntibiotics