眼镜蛇伤患者血清分泌型磷脂酶A2变化及价值探讨  

Changes and clinical significance of serum secretory phospholipase A2 in cobra bite patients

作　　者：吴小林[1] 宾文凯[1] 李威[1] 蒋华晓 周文浩 Wu Xiaolin;Bin Wenkai;Li Wei;Jiang Huaxiao;Zhou Wenhao(Emergency Department of Affiliated Nanhua Hospital,University of South China,Hengyang 421000,China)

机构地区：[1]南华大学附属南华医院急诊科,湖南省衡阳421000

出　　处：《中华急诊医学杂志》2018年第9期1015-1018,共4页Chinese Journal of Emergency Medicine

基　　金：衡阳市社会发展科技支撑计划（2014KS51）

摘　　要：目的探讨血清分泌型磷脂酶A2（secretory phospholipaseA2，sPLA2）与眼镜蛇伤患者病情严重程度的关系及意义。方法选取2015年1月至2015年12月期间南华大学附属南华医院急诊科按纳入标准和排除标准收治的眼镜蛇咬伤患者52例。按就诊时病情程度分为：轻型组及重危型组。按患肢的肿胀程度分为：轻度肿胀组及中重度肿胀组。按就诊时间差异分为A、B两组：就诊时间〈8h组与就诊时间≥8h组。健康成人志愿者20人为对照组。对不同分组进行血清sPLA2、C反应蛋白（CRP）、D二聚体（DD）、乳酸（LAC）及外周血白细胞计数（WBC）水平的测定和比较。计量资料采用成组t检验和秩和检验分析。结果轻型组、重危型组血清sPLA2水平与对照组比较，差异有统计学意义（P〈0．05）；轻型组及重危型组sPLA2水平比较，差异有统计学意义（P〈0．01）。轻度肿胀组及中重度肿胀组之间血清sPLA2水平进行比较，差异有统计学意义（P〈0．05）。眼镜蛇伤后患者就诊时间A组、B组血清sPLA2水平与对照组相比，差异有统计学意义（P〈0．05o患者sPLA2水平与LAC、DD、WBC水平正相关，其相关系数，分别为0．3142、0．2752、0．6534。结论血清sPLA2水平越高，则提示患者中毒症状越重，血清sPLA2对眼镜蛇伤病情的评估有一定的临床价值。Objective To investigate the relationship between serum secreted phospholipase A2 （sPLA2） and the severity of the disease in cobra bite patients. Methods Fifty-two cobra bite patients admitted to our hospital from January 2015 to December 2015 were selected according to the inclusion and exclusion criteria. According to the degree of disease, patients were divided into the light and heavy risk groups. According to the degree of swelling of the affected limbs, patients were divided into the mild swelling group and moderate-severe swelling group. According to the time difference between visits, patients were divided into： visit time 〈8 h group and visit time ≥ 8 h group. Twenty healthy adult volunteers served as the control group. The levels of serum sPLA2, C reactive protein （CRP）, D-dimer （DD）, lactic acid （LAC） and peripheral blood leukocyte count （WBC） were measured and compared in different groups. Quantitative data were analyzed using t test and rank sum test. Results The levels of serum sPLA2 in the light and heavy risk group were statistically different from those in the control group （P〈0.05）, and were statistically significant between the light and heavy risk groups （P〈0.01） and between the mild swelling group and moderate-severe swelling group （P〈0.05）. The serum sPLA2 levels in group A and group B were also significantly different from those in the control group （P〈0.05）. The level of sPLA2 was positively correlated with the level of LAC, DD and WBC, and the correlation coefficients were 0.314 2, 0.275 2 and 0.653 4, respectively. Conclusions The higher the level of serum sPLA2, the more serious the patient＇s poisoning symptoms. It is of certain clinical value to evaluate the condition of cobra.

关 键 词：分泌型磷脂酶A2 眼镜蛇咬伤 乳酸 D二聚体 C反应蛋白 

分 类 号：R646[医药卫生—外科学]