降钙素原指导抗生素策略对脓毒症患者抗菌药物使用的效果评价

Clinical effect of procalcitonin-guided therapy for antibiotic use in patients with sepsis

摘要:

目的  评价降钙素原（PCT）指导抗生素策略在脓毒症患者中应用的有效性，为临床决策提供参考依据。方法  计算机检索PubMed、EMbase、the Cochrane Library、Web of Science、CBMdisc、CNKI和万方数据库，收集关于PCT指导抗生素治疗脓毒症患者有效性的临床随机对照试验（RCT），检索时间从建库至2015年3月。由2位研究者按纳入标准独立筛选文献、提取资料并评价质量后，采用RevMan 5.3软件进行Meta分析。结果  纳入10个RCT，共1 620例患者。Meta分析结果提示，与常规治疗组比较，PCT指导组能够缩短抗生素使用时间和总住院时间[MD1=-1.41，（95%CI1：-2.15，-0.68），P 1=0.000；MD2=-2.98，（95%CI2：-4.92，-1.05），P 2=0.002]，而在院内病死率、28 d病死率和ICU住院时间方面比较，差异无统计学意义[RR1=0.98，（95%CI1：0.72，1.33），P 1=0.090；RR2=1.03，（95%CI2：0.85，1.24），P 2=0.770；MD3=-0.01，（95%CI3：-0.27，0.25），P 3=0.930]。结论  PCT指导抗生素策略能够缩短脓毒症患者的抗生素使用时间和总住院时间，而对院内病死率和28 d死亡率无明显影响。但尚需大样本、高质量的RCT验证。

Abstract:

Objective To explore the efficacy of procalcitonin (PCT) algorithms for antibiotic treatment decisions in adult patients with sepsis, so as to provide a reference for clinical decision. Methods PubMed, EMbase, the Cochrane Library, Web of Science, CBMdisc, CNKI and Wanfang databases were systematically searched for randomized controlled trials (RCT) of PCT algorithms for antibiotic treatment in adult patients with sepsis. Study selection, data extraction and quality assessment were applied independently by two reviewers, and then RevMan 5.2 software was used for conducting meta-analysis. Results A total of 10 RCTs including 1,620 patients were included. The results of meta-analysis demonstrated that compared with the control group, the PCT-guided group significantly reduced the duration of antibiotic treatment and hospital stay [MD1 = -1.41, 95% CI1 : (-2.15, -0.68），P1 = 0.000; MD2 = -2.98, 95% CI2 : (-4.92, -1.05), P2 = 0.002]; while there were no statistical differences in hospital mortality, 28-day mortality or duration of hospital stay in ICU between the two groups [RR1= 0.98, 95% CI1 : (0.72, 1.33）, P1 = 0.090; RR2 = 1.03, 95% CI2 : (0.85, 1.24)，P2 = 0.770; MD3 = -0.01, 95% CI3 : (-0.27, 0.25), P3 = 0.930]. Conclusions PCT-guided therapy may reduce the duration of antibiotic treatment and hospital stay without affecting hospital mortality or 28-day mortality. However, high-quality and large-scale randomized controlled trials are still needed to confirm our study.