소아 하기도 호흡기 감염에서 항생제 치료 가이드라인으로서의 혈청 procalcitonin의 임상적 유용성
Clinical Usefulness of Procalcitonin as Guideline of Antibiotic Treatment in Children with Respiratory Tract Infection
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목 적:칼시토닌의 전구 물질인 혈청 procalcitonin (PCT)은 세균성 감염 및 염증 반응의 새로운 표지자로 제안되어 이에 본 연구는 항생제의 불필요한 사용을 예방하기 위해 소아의 하기도 호흡기 감염에서 혈청 PCT의 임상적 유용성을 알아보고자 한다. 방 법:2010년 3월부터 2010년 12월까지 충남대학교 병원 소아청소년과에 입원하여 하기도 호흡기 감염으로 치료받은 5세 미만의 환아 88명을 대상으로 하였다. 입원 당시 말초혈액 백혈구 수, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), PCT을 측정하였고, 원인균 확인을 위해 입원 당시 혈액배양 검사 및 바이러스 다중 역전사 중합효소 연쇄반응(reverse transcription- polymerase chain reaction) 검사를 시행하였다. 임상 양상은 후향적으로 조사하였다. 결 과:대상 환아의 평균 나이는 1.9±1.5세였다. Receiver operating characteristic 곡선에서 PCT 값의 cut-off값은 0.11 ng/mL이었다. 혈청 PCT 값이 0.11 ng/mL 미만으로서 혈청 PCT 값이 낮은 군으로 분류된 29명 환아에서 항생제 사용 유무에 따른 임상 증상, 말초혈액 백혈구 수, ESR 및 CRP 값은 유의한 차이를 보이지 않았다. 반면, 혈청 PCT 값이 높은 군(PCT≥0.11 ng/mL)에서 항생제 사용이 환자들의 입원 기간(P=0.005)과 입원 후 발열 기간(P= 0.054)을 호전시키는데 도움이 되었다. 결 론:소아 하기도 호흡기 감염에서 혈청 PCT 측정값(0.11 ng/mL)이 항생제 치료 여부를 결정하는데 필요한 요소로 활용되고, 불필요한 항생제 사용을 감소시키는데 기여할 것으로 기대된다.
Abstract
Purpose:Procalcitonin (PCT), a precursor of calcitonin, has been described as a biomarker of bacterial infection and inflammation. This study was performed to evaluate the clinical usefulness of PCT levels and to reduce the unnecessary usage of antibiotics in children with lower respiratory tract infection (RTI). Methods:Eighty-eight children, with lower RTI, under the age of 5 years, who were admitted to Chungnam National University Hospital, between May 2010 and December 2010, were enrolled. White blood cell counts, erythrocyte sedimentation rate, C-reactive protein, and PCT were measured. Blood and sputum cultures were performed to identify the causative bacteria and reverse transcription-polymerase chain reaction for the viruses. Clinical features were reviewed, retrospectively. Results:The mean participant age was 1.9±1.5 years. The cut-off value for serum PCT levels, which was derived from the receiver-operator characteristic curve, was 0.11 ng/mL. In 29 patients (33.0%) with low PCT levels (<0.11 ng/mL), antibiotic therapy showed no benefit for clinical and laboratory findings. However, in 59 patients (67.1%) with high PCT levels (≥0.11 ng/mL), hospitalization (P=0.005) and fever (P=0.054) exhibited a shorter duration, after antibiotic therapy. Conclusion:A single initial serum PCT levels (≥0.11 ng/mL) may be clinically useful to give a guideline for antibiotic treatment in children with lower respiratory tract infection and to reduce the unnecessary usage of antibiotics.
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