急性肾损伤网络分期在急性百草枯中毒中的预后价值  

The prognostic value of the Acute Kidney Injury Network criteria in patients with acute paraquat poisoning

作　　者：刘尊齐[1] 纪宏斌[1] 王海石[1] 张兴国[1] 谷燕[1] 商德亚[1] 刘东兴[1] 郝凤桐[2] 

机构地区：[1]山东大学附属省立医院急救中心,济南250021 [2]北京朝阳医院职业病科,100043

出　　处：《中华危重病急救医学》2014年第4期223-227,共5页Chinese Critical Care Medicine

基　　金：卫生行业科研专项项目（201202006-06）

摘　　要：目的 探讨临床应用急性肾损伤网络（AKIN）分期标准对急性百草枯（PQ）中毒患者预后的价值.方法 回顾性分析山东省立医院2010年4月至2013年3月收治的184例口服PQ中毒患者的临床资料,比较存活组和死亡组患者的各种临床指标和AKIN分期,采用Cox比例风险回归模型进行多因素分析,Kaplan-Meier法对不同AKIN分期患者进行生存分析.结果 184例PQ中毒患者死亡79例,病死率42.93％.死亡组和存活组之间性别、是否合并饮酒、服毒至洗胃时间、服毒至首次灌流时间、血液灌流次数差异均无统计学意义;年龄、服毒量、是否血液净化、AKIN分期,以及入院时白细胞计数、中性粒细胞比例、血糖、血尿素氮、肌酐、β2-微球蛋白（β2-MG）、血清K＋、CO2总量、阴离子间隙和尿PQ浓度等14项指标差异明显,其中AKIN分期[优势比（OR）=3.242,95％可信区间（95％CI）为2.236～4.701,P=0.000]、尿PQ浓度（OR=1.773,95％CI为1.008 ～ 3.116,P=0.047）、服毒量（OR=1.003,95％CI为1.000～ 1.006,P=0.040）和CO2总量（OR =0.094,95％CI为0.891 ～ 0.991,P=0.021）是死亡的独立预后因素.Kaplan-Meier生存分析显示,AKIN 3期患者生存率明显低于AKIN 2期（5.88％比56.25％,x2=16.149,P=0.000）、AKIN 1期（5.88％比78.95％,x2=62.444,P=0.000）和肾功能正常者（5.88％比100.0％,x2=173.549,P=0.000）.结论 AKIN分期是PQ中毒患者可靠的预后预测因素.在没有开展血浆PQ浓度测定的医院,应用AKIN分期可以作为评估PQ中毒严重性的简单而实用的工具.Objective To explore the prognostic value of the Acute Kidney Injury Network （AKIN） criteria in patients with acute paraquat （PQ） poisoning.Methods A retrospective study on 184 patients with acute PQ poisoning admitted to the Shandong Provincial Hospital from April 2010 to March 2013 was done.The clinical data and AKIN stage were compared between survivors and non-survivors,and multivariate analysis was done by Cox-proportional hazards regression model.Kaplan-Meier method was used to analyze survival rate of the patients in different stages of poisoning.Results The 60-day mortality was 42.93％ （79/184）.There were no significant differences between the survival and non-survival groups in respect of gender,simultaneous alcohol drinking,duration between ingestion and gastric lavage,duration between ingestion and first hemoperfusion,and number of hemoperfusion.Significant differences were found between two groups in age,quantity of ingestion,receiving hemoperfusion or not,AKIN stage,and initial laboratory data including white blood cell count,the percentage of neutrophil,blood glucose,blood urea nitrogen,creatinine,β2-microglobulin （β2-MG）,serum K＋,CO2,anion gap,and urinary concentration of PQ.The AKIN stage [odds ratio （OR） =3.242,95％ confidence interval （95％CI）2.236-4.701,P=0.000],urinary concentrations of PQ （OR=1.773,95％CI 1.008-3.116,P=0.047）,the amount of ingestion （OR=1.003,95％CI 1.000-1.006,P=0.040）,and CO2 （OR =0.094,95％ CI 0.891-0.991,P=0.021） were independent prognostic factors for death among them.Kaplan-Meier survival analysis showed the survival rate of AKIN 3 group was significantly lower than that in AKIN 2 group （5.88％ vs.56.25％,x2=16.149,P=0.000）,AKIN 1 group （5.88％ vs.78.95％,x2=62.444,P=0.000） and non-AKI group （5.88％ vs.100.0％,x2=173.549,P=0.000）.Conclusions The AKIN staging is a reliable marker for mortality prediction in acute PQ poisoning patients.In cases without facilities to determine plasma PQ concentration,the stagi

关 键 词：百草枯 中毒 急性肾损伤网络分期标准 预后 

分 类 号：R595.4[医药卫生—内科学]