可溶性髓细胞表达触发受体-1测定对慢性阻塞性肺病急性加重期抗菌治疗的指导意义
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The value of serum soluble triggering receptor expressed on myeloid cell-1 in treatment of acute exacerbations of chronic obstructive pulmonary disease
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    目的:研究可溶性髓细胞表达触发受体-1(soluble triggering receptor expressed on myeloid cells-1,sTREM-1)在慢性阻塞性肺病急性加重(AECOPD)患者治疗时指导抗菌药物使用的临床意义-方法:选取2007年8月~2009年2月246例AECOPD患者,随机分配为常规治疗组(123例)和sTREM-1指导组(123例),入院后分别在d1用双抗体夹心ELISA法检测血清sTREM-1水平-在相同常规治疗基础上,常规治疗组患者由经治医师按照抗菌药物使用指南决定抗菌药物治疗方案,sTREM-1指导组患者按照血清sTREM-1水平决定是否使用抗菌药物,在血清sTREM-1≥20 ng/ml时,进行抗菌药物治疗,sTREM-1<20 ng/mL且C反应蛋白(CRP)<5 mg/L时,不予抗菌药物治疗-观察两组患者的住院时间-临床有效率-住院费用-抗菌药物费用-住院病死率-1年随访期间AECOPD发生率及住院率-结果:两组患者在临床有效率-住院病死率-住院时间-1年随访期间AECOPD发生率及住院率方面差异无统计学意义(P分别为 0.621-0.734-0.571-0.793和0.883),sTREM-1指导治疗组的抗菌药物费用及住院费用均低于常规治疗组(P分别为0.000和0.026)-结论:AECOPD患者入院之初进行sTREM-1水平检测可以作为指导抗菌药物使用的参考指标,有利于降低抗菌药物使用费用和总住院费用-

    Abstract:

    Objective: To evaluate the value of serum soluble triggering receptor expressed on myeloid cells-1(sTREM-1) on antibacterial agents useage in treatment of acute exacerbations of chronic obstructive pulmonary disease(AECOPD). Method: From August 2007 to February 2009,a total of 246 patients requiring hospitalization for AECOPD were randomly assigned into two groups:standard therapy group(n = 123) and sTREM-1-guided group(n = 123). Serum sTREM-1 levels of all patients were measured after hospital admission by enzme-linked immunosorbent assay. On the base of similarly normal treatment,standard therapy group received antibacterial agents according to guideline for antimicrobial drug useage,and sTREM-1-guided group were treated with antibacterial agents according to serum sTREM-1 levels:antibacterial agents treatment was applied when sTREM-1 level≥20ng/ml and was discouraged when sTREM-1 level < 20 ng/ml and CRP< 5 mg/L. Length of hospitalization,clinical efficacy,costs of hospitalization and antibacterial agents,hospital mortality,rate of exacerbation and rehospitalization within 1 year were observed. Results: Clinical efficacy,hospital mortality,length of hospitalization,rate of exacerbation and rehospitalization within 1 year were similar in two groups(P = 0.621-0.734,0.571,0.793 and 0.883);costs of antibacterial agents and hospitalization of sTREM-1-guided group were lower than that of standard therapy group(P = 0.000和0.026). Conclusion: sTREM-1 could be detected as a reference for guiding the use of antibacterial agents for AECOPD treatment which may reduce the costs of antibacterial agents and hospitalization.

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朱 蓉,洪永青,陈 亮,孟自力.可溶性髓细胞表达触发受体-1测定对慢性阻塞性肺病急性加重期抗菌治疗的指导意义[J].南京医科大学学报(自然科学版),2011,(11):1645-1648

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  • 收稿日期:2011-07-09
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