急性百草枯中毒肾损伤指标动态变化的临床研究  

Clinical studies of dynamic changes on the renal injury indicators of acute paraquat poisoning

作　　者：阚宝甜[1] 刘会敏[1] 菅向东[1] 张伟[1] 周倩[1] 王洁茹[1] 

机构地区：[1]山东大学齐鲁医院中毒与职业病科,济南250012

出　　处：《中华劳动卫生职业病杂志》2012年第11期839-841,共3页Chinese Journal of Industrial Hygiene and Occupational Diseases

基　　金：山东省自然科学基金项目Y2008C123

摘　　要：目的探讨血清尿素氮（BUN）、肌酐（cr）、胱抑素（CysC）及尿蛋白的动态变化在急性百草枯中毒患者肾功能损害的临床意义。方法研究分析35例百草枯中毒患者的临床资料，以8周后存活为标准，于患者中毒的第1、3、7、14、2l天及8周后分别采取空腹静脉血5ml，全自动生化仪测定血清BUN、Cr、CysC，并留取中段晨尿测尿蛋白的水平；同时随机选取30例健康体检者作正常对照组，并排除肾脏疾病及其他泌尿系统疾病史，于查体当天采取静脉血5ml并留取尿液检测上述指标。结果观察期前21d中毒存活组血清BUN、Cr、CysC的水平（9．08±3．37）mmol／L、（169．3±21．3）μmol／L和（2．01±0．83）mg／L]对照组（4．57±1．45）mmol／L、（68．8±15．0）μmol／L和（0．81±0．26）mg／L]均明显升高，差异有统计学意义（P〈0．05）。百草枯中毒第14天，各指标都有一定程度的回落，且血清CysC下降的幅度低于血清BUN、Cr。第21天，35例存活患者中有29例上述肾功能指标恢复至正常参考值范围，8周后有31例恢复至正常范围，尿蛋白的阳性率在。肾损伤早期相对较高（76．9％）。结论血清CysC是反映百草枯急性中毒肾损伤的一项灵敏指标，其灵敏度优于BUN、Cr和尿蛋白，百草枯中毒所致的肾损伤具有可逆性。Objective To investigate the clinical significance of dynamic changes of blood urea nitrogen （BUN）, serum ereatinine （Cr）, serum cystatin （Cys C） and urinary protein on renal injurys with paraquat poisoning. Methods According to the clinical manifestion and curative effect,the clinical information was analyzed retrospectively in 35 cases of acute paraquat poisoning, survival after eight weeks as the standard. Poisoning patients were taken a fasting blood 5 ml and the middle of urina on the 1st day,3rd day,7th day,14th day,21st day and 8 weeks after the poisoning. Then the levels of serum BUN,Cr,Cys C and urinary protein were detected by automatic biochemistry analyzer. 30 cases healthy subjects were randomly selected as normal control group, and discharged kidney disease and other diseases of urinary system history. The same laboratory subjects have been done. Results The level of serum Bun, Cr, Cys C of survival group increased significantly compared with control group within 21 days （P〈0.05）. The level of serum BUN, Cr Cys C decreasd on the 14th day. The decreased level of serum Cys C was lower than that of serum BUN and Cr. The renal function of 29 cases among 35 cases survival patients recovered on 21st day. The renal function of 31 cases among 35 cases survival patients recovered 8 weeks late. The positive rate of urinary protein of survival patients was high in the early intoxication （76.9%）. Conclusion Serum Cys C is sensitive indicator to reveal the kidney injury on paraquat poisoning patients and have higher value of clinical applications in the diagnosis of the kidney injury of paraquat poisoning,which sensitivity is higher than serum BUN and Cr. The kidney injury caused by paraquat poisoning is reversible.

关 键 词：百草枯 肌酐 尿素氮 胱抑素C 

分 类 号：R595.4[医药卫生—内科学]