ty -jour t1- COPD中的炎症生物标志物指导抗生素治疗？Wall JF中的另一块砖 - 欧洲呼吸杂志JO -EUR RESSIR J DO -10.1183/13993003.00562-2019 VL -53 IS -5 SP -1900562 AU -Schuetz，Philipp au -Stolz，Daiana Y1 Y1-119/05/01 UR--//www.qdcxjkg.com/content/53/5/5/1900562.Abstract N2-慢性阻塞性肺疾病（COPD）的急性加重通常会引起经验抗生素治疗的启动，尽管在许多情况下无法检测到细菌病原体病毒确实可以解释很大一部分发作。实际上，支持广泛的抗生素利用在加剧时不需要重症监护的数据不足。在此，基于患者的个人患细菌感染风险的个性化抗生素治疗具有改善抗生素管理努力的巨大潜力，以鼓励明智的使用并纠正这些药物的使用，并减轻耐多药的病原体的出现，这是对全球健康最紧迫的威胁之一并直接与抗生素过度使用有关。与细菌感染相关的宿主反应标记的整合与COPD急性加重患者的总体评估和临床护理相关，具有改善单个抗生素决策的高潜力。在这种有前途的宿主反应标记中，在COPD的急性加重中，普罗维素（PCT）（PCT）是细菌感染的特异性标记和C反应蛋白（CRP）（CRP），这是一种具有较高敏感性的更普遍的炎症标记，具有最高的敏感性。几项随机试验发现PCT可显着降低抗生素使用情况，在脓毒症和呼吸道感染患者中，临床症状的分辨率相似，包括COPD的急性加重[1，2]。 In fact, a meta-analysis based on individual data of 1252 patients with COPD exacerbation found PCT guidance to result in a significant reduction in antibiotic initiation (72% versus 43%) and antibiotic exposure (5.3 versus 3.1 days) with no difference in mortality (4% versus 3%) or risk of treatment failure (17% versus 17%) [3]. Still, a recent trial investigating COPD patients needing intensive care treatment did not report a significant effect of PCT on antibiotic usage, and non-inferiority of PCT in regard to clinical outcomes could not be demonstrated [4]. CRP has been used successfully to direct antibiotic treatment in primary care studies [5, 6], and observational research suggested CRP may be more suitable to direct antibiotic treatment in acute exacerbation of COPD compared to PCT [7]. Still, randomised trials looking at the effect of CRP for guiding antibiotic decisions in patients with acute COPD exacerbation have been largely missing.More studies are needed to guide antibiotic treatment with inflammatory biomarkers in COPD http://ow.ly/bJcJ30oklR2 ER -