{"id":17471,"date":"2019-07-17T05:37:13","date_gmt":"2019-07-16T21:37:13","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=17471"},"modified":"2019-08-06T11:22:47","modified_gmt":"2019-08-06T03:22:47","slug":"nejm%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9acrp%e6%a3%80%e6%b5%8b%e6%8c%87%e5%af%bcaecopd%e7%9a%84%e6%8a%97%e7%94%9f%e7%b4%a0%e4%bd%bf%e7%94%a8","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=17471","title":{"rendered":"[NEJM\u53d1\u8868\u8bba\u6587]\uff1aCRP\u68c0\u6d4b\u6307\u5bfcAECOPD\u7684\u6297\u751f\u7d20\u4f7f\u7528"},"content":{"rendered":"\n

ORIGINAL ARTICLE<\/a><\/h3>\n\n\n\n

C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations<\/h1>\n\n\n\n

Christopher C. Butler, David Gillespie, Patrick White, et al<\/h3>\n\n\n\n

N Engl J Med 2019; 381:111-120
DOI: 10.1056\/NEJMoa1803185<\/h3>\n\n\n\n

Abstract<\/h2>\n\n\n\n

BACKGROUND \u80cc\u666f<\/h3>\n\n\n\n

Point-of-care testing of C-reactive protein (CRP) may be a way to reduce unnecessary use of antibiotics without harming patients who have acute exacerbations of chronic obstructive pulmonary disease (COPD).<\/p>\n\n\n\n

\u5e8a\u65c1C\u53cd\u5e94\u86cb\u767d(CRP)\u68c0\u6d4b\u53ef\u80fd\u51cf\u5c11COPD\u6025\u6027\u52a0\u91cd(AECOPD)\u60a3\u8005\u4e0d\u5fc5\u8981\u7684\u6297\u751f\u7d20\u4f7f\u7528\uff0c\u540c\u65f6\u4e5f\u4e0d\u9020\u6210\u5371\u5bb3<\/p>\n\n\n\n

METHODS \u65b9\u6cd5<\/h3>\n\n\n\n

We performed a multicenter, open-label, randomized, controlled trial involving patients with a diagnosis of COPD in their primary care clinical record who consulted a clinician at 1 of 86 general medical practices in England and Wales for an acute exacerbation of COPD. The patients were assigned to receive usual care guided by CRP point-of-care testing (CRP-guided group) or usual care alone (usual-care group). The primary outcomes were patient-reported use of antibiotics for acute exacerbations of COPD within 4 weeks after randomization (to show superiority) and COPD-related health status at 2 weeks after randomization, as measured by the Clinical COPD Questionnaire, a 10-item scale with scores ranging from 0 (very good COPD health status) to 6 (extremely poor COPD health status) (to show noninferiority).<\/p>\n\n\n\n

\u6211\u4eec\u8fdb\u884c\u4e86\u4e00\u9879\u591a\u4e2d\u5fc3\u3001\u5f00\u653e\u6807\u7b7e\u3001\u968f\u673a\u5bf9\u7167\u8bd5\u9a8c\uff0c\u5728\u82f1\u683c\u5170\u548c\u5a01\u5c14\u58eb\u768486\u4e2a\u5168\u79d1\u533b\u7597\u4e2d\u5fc3\u7eb3\u5165\u8bca\u65ad\u4e3aAECOPD\u7684\u60a3\u8005\u3002\u60a3\u8005\u63a5\u53d7\u968f\u673a\u5206\u7ec4\uff0c\u5206\u522b\u63a5\u53d7\u5e8a\u65c1CRP\u68c0\u6d4b\u6307\u5bfc\u7684\u5e38\u89c4\u6cbb\u7597\uff08CRP\u6307\u5bfc\u7ec4\uff09\u6216\u5e38\u89c4\u6cbb\u7597\uff08\u5e38\u89c4\u6cbb\u7597\u7ec4\uff09\u3002\u4e3b\u8981\u9884\u540e\u6307\u6807\u4e3a\u968f\u673a\u5206\u7ec4\u540e4\u5468\u5185\u60a3\u8005\u62a5\u544a\u7684\u56e0AECOPD\u7684\u6297\u751f\u7d20\u4f7f\u7528\u60c5\u51b5\uff08\u4f18\u6548\uff09\u4ee5\u53ca\u968f\u673a\u5206\u7ec4\u540e2\u5468\u65f6COPD\u76f8\u5173\u5065\u5eb7\u72b6\u51b5\uff08\u975e\u52a3\u6548\uff09\uff0c\u540e\u8005\u901a\u8fc7\u4e34\u5e8aCOPD\u95ee\u5377\u8bc4\u4ef7\uff0c\u8fd9\u662f\u4e00\u4e2a\u5305\u62ec10\u9879\u95ee\u9898\u7684\u8bc4\u5206\uff0c\u5206\u503c\u4ece0\u5206\uff08COPD\u5065\u5eb7\u72b6\u51b5\u6781\u4f73\uff09\u52306\u5206\uff08COPD\u5065\u5eb7\u72b6\u51b5\u6781\u5dee\uff09\u3002<\/p>\n\n\n\n

RESULTS \u7ed3\u679c<\/h3>\n\n\n\n

A total of 653 patients underwent randomization. Fewer patients in the CRP-guided group reported antibiotic use than in the usual-care group (57.0% vs. 77.4%; adjusted odds ratio, 0.31; 95% confidence interval [CI], 0.20 to 0.47). The adjusted mean difference in the total score on the Clinical COPD Questionnaire at 2 weeks was \u22120.19 points (two-sided 90% CI, \u22120.33 to \u22120.05) in favor of the CRP-guided group. The antibiotic prescribing decisions made by clinicians at the initial consultation were ascertained for all but 1 patient, and antibiotic prescriptions issued over the first 4 weeks of follow-up were ascertained for 96.9% of the patients. A lower percentage of patients in the CRP-guided group than in the usual-care group received an antibiotic prescription at the initial consultation (47.7% vs. 69.7%, for a difference of 22.0 percentage points; adjusted odds ratio, 0.31; 95% CI, 0.21 to 0.45) and during the first 4 weeks of follow-up (59.1% vs. 79.7%, for a difference of 20.6 percentage points; adjusted odds ratio, 0.30; 95% CI, 0.20 to 0.46). Two patients in the usual-care group died within 4 weeks after randomization from causes considered by the investigators to be unrelated to trial participation.<\/p>\n\n\n\n

\u5171\u6709653\u540d\u60a3\u8005\u63a5\u53d7\u968f\u673a\u5206\u7ec4\u3002\u4e0e\u5e38\u89c4\u6cbb\u7597\u7ec4\u76f8\u6bd4\uff0cCRP\u6307\u5bfc\u7ec4\u66f4\u5c11\u60a3\u8005\u62a5\u544a\u4f7f\u7528\u6297\u751f\u7d20\uff0857.0% vs. 77.4%\uff1b\u6821\u6b63\u540e\u6bd4\u6570\u6bd4\uff0c0.31; 95%\u53ef\u4fe1\u533a\u95f4[CI], 0.20 to 0.47\uff09\u30022\u5468\u65f6\uff0c\u4e24\u7ec4\u60a3\u8005\u4e34\u5e8aCOPD\u95ee\u5377\u603b\u5206\u6821\u6b63\u540e\u5e73\u5747\u5dee\u4e3a\u22120.19\u5206\uff08\u53cc\u4fa790% CI, \u22120.33 to \u22120.05\uff09\uff0cCRP\u6307\u5bfc\u7ec4\u66f4\u4f4e\u3002\u96641\u540d\u60a3\u8005\u5916\uff0c\u6240\u6709\u60a3\u8005\u5728\u6700\u521d\u5c31\u8bca\u65f6\uff0c\u4e34\u5e8a\u533b\u751f\u5904\u65b9\u6297\u751f\u7d20\u7684\u60c5\u51b5\u5747\u5df2\u660e\u786e\uff0c96.9%\u7684\u60a3\u8005\u6700\u521d4\u5468\u968f\u8bbf\u671f\u95f4\u7684\u6297\u751f\u7d20\u5904\u65b9\u60c5\u51b5\u4e5f\u5df2\u660e\u786e\u3002\u4e0e\u5e38\u89c4\u6cbb\u7597\u7ec4\u76f8\u6bd4\uff0c\u6700\u521d\u5c31\u8bca\u65f6\uff0847.7% vs. 69.7%\uff0c\u5dee\u5f02\u4e3a22.0\u4e2a\u767e\u5206\u70b9\uff1b\u6821\u6b63\u540e\u6bd4\u6570\u6bd4\uff0c0.31\uff1b95% CI, 0.21 to 0.45\uff09\u4ee5\u53ca\u6700\u521d4\u5468\u968f\u8bbf\u671f\u95f4\uff0859.1% vs. 79.7%\uff0c\u5dee\u5f02\u4e3a20.6\u4e2a\u767e\u5206\u70b9\uff1b\u6821\u6b63\u540e\u6bd4\u6570\u6bd4\uff0c0.30; 95% CI, 0.20 to 0.46\uff09\uff0cCRP\u6307\u5bfc\u7ec4\u66f4\u5c11\u60a3\u8005\u4f7f\u7528\u6297\u751f\u7d20\u3002\u968f\u673a\u5206\u7ec4\u540e4\u5468\u5185\uff0c\u5e38\u89c4\u6cbb\u7597\u7ec42\u540d\u60a3\u8005\u6b7b\u4ea1\uff0c\u7814\u7a76\u8005\u5224\u65ad\u6b7b\u56e0\u4e0e\u53c2\u52a0\u4e34\u5e8a\u8bd5\u9a8c\u65e0\u5173\u3002<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

CONCLUSIONS \u7ed3\u8bba<\/h3>\n\n\n\n

CRP-guided prescribing of antibiotics for exacerbations of COPD in primary care clinics resulted in a lower percentage of patients who reported antibiotic use and who received antibiotic prescriptions from clinicians, with no evidence of harm.<\/p>\n\n\n\n

\u5728\u5168\u79d1\u533b\u7597\u8bca\u6240\u91c7\u7528CRP\u6307\u5bfc\u6297\u751f\u7d20\u5904\u65b9\uff0c\u80fd\u591f\u51cf\u5c11AECOPD\u60a3\u8005\u62a5\u544a\u7684\u6297\u751f\u7d20\u4f7f\u7528\uff0c\u540c\u65f6\u51cf\u5c11\u4f7f\u7528\u4e34\u5e8a\u533b\u751f\u5904\u65b9\u6297\u751f\u7d20\u7684\u60a3\u8005\u6bd4\u4f8b\uff0c\u4e14\u6ca1\u6709\u9020\u6210\u5371\u5bb3\u7684\u8bc1\u636e\u3002<\/p>\n\n\n\n

(Funded by the National Institute for Health Research Health Technology Assessment Program; PACE Current Controlled Trials number, ISRCTN24346473<\/a>.)<\/p>\n\n\n\n

[\u8bc4\u8bba]\uff08\u4ec5\u4ee3\u8868\u4e2a\u4eba\u89c2\u70b9\uff09<\/h3>\n\n\n\n

\u8fd9\u4e0d\u662f\u9488\u5bf9\u5371\u91cd\u75c5\u60a3\u8005\u7684\u7814\u7a76\uff0c\u4f46\u5bf9\u6211\u4eec\u6216\u8bb8\u6709\u4e00\u4e9b\u63d0\u793a\u3002\u53d7\u8fd9\u4e2a\u7814\u7a76\u7684\u542f\u53d1\uff0c\u662f\u5426\u4f1a\u6709\u7814\u7a76\u8005\u9488\u5bf9\u53ef\u7591\u611f\u67d3\u7684ICU\u60a3\u8005\uff0c\u6bd4\u8f83CRP\u548cPCT\u6307\u5bfc\u6297\u751f\u7d20\u6cbb\u7597\u7684\u5dee\u5f02\uff1f<\/p>\n\n\n\n

\u9700\u8981\u56de\u7b54\u7684\u4e34\u5e8a\u95ee\u9898\u53ef\u80fd\u5305\u62ec\uff1a<\/p>\n\n\n\n

  • \u76ee\u524d\u4e34\u5e8aPCT\u68c0\u6d4b\u662f\u5426\u8fc7\u6ee5\uff1f<\/li>
  • \u751f\u7269\u6807\u5fd7\u7269\uff08PCT\uff0cCRP\uff09\u771f\u7684\u80fd\u591f\u6307\u5bfc\u6297\u751f\u7d20\u6cbb\u7597\u5417\uff1f<\/li>
  • \u5728\u6307\u5bfc\u6297\u751f\u7d20\u6cbb\u7597\u65b9\u9762\uff0cPCT\u771f\u7684\u4f18\u4e8eCRP\u5417\uff1fPCT\u771f\u7684\u4f18\u4e8e\u4e34\u5e8a\u5224\u65ad\u5417\uff1f<\/li>
  • \u5728\u793e\u533a\u83b7\u5f97\u6027\u4e0b\u547c\u5438\u9053\u611f\u67d3\u60a3\u8005\u5f97\u5230\u7684\u7ed3\u8bba\u80fd\u5426\u9002\u7528\u4e8e\u5371\u91cd\u75c5\u60a3\u8005\uff1f<\/li><\/ul>\n\n\n\n

    <\/p>\n","protected":false},"excerpt":{"rendered":"

    ORIGINAL ARTICLE C-Reactive Protein Testing to Guide An […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17471"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=17471"}],"version-history":[{"count":3,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17471\/revisions"}],"predecessor-version":[{"id":17499,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17471\/revisions\/17499"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=17471"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=17471"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=17471"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}