早期中性粒细胞/淋巴细胞比值联合血清二氧化碳浓度对急性百草枯中毒预后的影响分析  

Prognostic value of initial neutrophil/lymphocyte ratio and total plasma carbon dioxide in acute paraquat poisoning

作　　者：卞恒娟 陈虎[2] 李景荣[1] 程景林[1] Bian Heng-juan;Chen Hu;Li Jing-rong;Cheng Jing-lin(Emergency Department,the Second Afiliated Haspital of Anhui Medical University,Hefei 230601,China)

机构地区：[1]安徽医科大学第二附属医院急诊内科,安徽合肥230601 [2]安徽医科大学第二附属医院重症医学科,安徽合肥230601

出　　处：《中国急救医学》2020年第7期601-605,共5页Chinese Journal of Critical Care Medicine

基　　金：安徽医科大学校科研基金(2017xkj046)。

摘　　要：目的探讨分析急性百草枯(paraquat,PQ)中毒早期检测中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)和血清总二氧化碳浓度(total plasma carbon dioxide,T-CO2),以及两者联合检测与急性PQ中毒预后的相关性.方法对2011年1月1日至2018年12月31日在安徽医科大学第二附属医院就诊的146例急性PQ中毒患者临床资料进行回顾性分析,根据30 d后转归情况分为生存组和死亡组;比较两组口服PQ毒物剂量、洗胃时间、血白细胞计数(WBC)、中性粒细胞计数(absolute neutrophil count,ANC)、淋巴细胞计数(total lymphocyte count,TLC)、NLR、血淀粉酶、血肌酐(Cr)、T-CO2、血钾(K^+)、肌酸激酶同工酶(CK-MB)、谷丙转氨酶(alanine aminotransferase,ALT)的差异;建立多因素Logistic二元回归模型,评价急性PQ中毒的预后危险因素;绘制受试者工作特征(receiver operator characteristic,ROC)曲线,评价NLR及T-CO2对预后的预测价值.结果纳入的146例患者,生存组40例,死亡组106例(病死率72.6%);二元Logistic回归模型分析显示,NLR(OR 0.131,95%CI0.033~0.527,P<0.05)和T-CO2(OR6.650,95%CI1.894~23.340,P<0.05)是急性PQ中毒患者的独立危险因素;ROC曲线显示,NLR曲线下面积(area under the curve,AUC)0.756(95%CI0.662~0.850,P<0.001),最佳界值8.80,对应的敏感度72.6%,特异度72.5%;T-CO2 AUC 0.877(95%CI0.822~0.933,P<0.001),最佳界值21.6 mmol/L,对应的敏感度78.3%,特异度77.5%.NLR联合T-CO2AUC为0.906(95%CI0.859~0.954,P<0.001).结论NLR和T-CO2可作为急性PQ中毒预后的独立影响因素,两者联合检测对预后具有较高的预测价值.Objective To investigate the prognostic value of the initial neutrophil/lymphocyte ratio(NLR)and total plasma carbon dioxide(T-CO2)in acute paraquat poisoning.Methods We respectively reviewed the climical parameters of 146 patients with acute paraquat poisoning.According to 30-day outcome,the patients were divided into survival and no-survival groups.The oral toxicity dose,gastric lavage time,WBC,absolute neutrophil count(ANC),total lymphocyte count(TLC),NLR,blood amylase,blood creatinine,T-CO2,blood potassium,CK-MB,alanine aminotransferase(ALT)were compared between the two groups.Multivariate Logistic regression was performed to identify risk factors of 30-day mortality.Receiver operator characteristic curve(ROC)was plotted to evaluate the prognostie value of NLR and T-CO2 in acute paraquat poisoning patients.Results There are 146 cases in total with 40 survivors and 106 deaths in 30 days.Analysis of binary Logistic regression model showed that NLR(OR 0.131,95%CI0.033-0.527,P<0.05)and T-CO,(OR 6.650,95%CI 1.894-23.340,P<0.05)were independent risk faclors for poisoning patients.ROC showed that the AUC for NLR was 0.756(95%CI 0.662-0.850,P<0.001),with a cutoff threshold of 8.80,the sensitivity was 72.6%and specifeity was 72.5%,AUC ofT-CO2 was 0.877(95%CIO.822-0.933,P<0.001),eutoff threshold was 21.6 mmol/L,the sensitivity was 78.3%and specificity was 77.5%.AUCofNLR+T-CO2was0.906(95%CI0.859-0.954,P<0.001).ConclusionThe combination of NLR and T-CO2 has a high predictive value for the prognosis of paraquat poisoning.

关 键 词：中性粒细胞/淋巴细胞比值(NLR) 血清总二氧化碳浓度(T-CO2) 百草枯(PQ) 中毒 预后 

分 类 号：R595.4[医药卫生—内科学]