血细胞比容与白蛋白差值评估急性百草枯中毒程度的临床研究  

Clinical research of the differences between hematocrit and serum albumin for evaluating the severity of acute paraquat poisoning

作　　者：左瑞玲 谢媛 张伟[1] 胡锐[1] 郑粉双 Zuo Ruiling;Xie Yuan;Zhang Wei;Hu Rui;Zheng Fenshuang(Department of Emergency Medicine,the Affiliated Hospital of Yunnan University,the Second People's Hospital of Yunnan Province,Kunming 650021,Yunnan,China)

机构地区：[1]云南大学附属医院(云南省第二人民医院)急诊医学部,昆明650021

出　　处：《中华危重病急救医学》2021年第8期999-1002,共4页Chinese Critical Care Medicine

基　　金：云南省基础研究计划项目(2019FE001-255);云南省院士专家工作站项目(2021-1)。

摘　　要：目的探讨血细胞比容与白蛋白差值(HCT-ALB)评估急性百草枯(PQ)中毒患者中毒程度的临床价值。方法选择云南省第二人民医院2018年1月至2019年12月收治的急性PQ中毒患者作为研究对象,以同期健康体检者作为对照。收集患者的一般情况、中毒量、中毒时间,以及入院时未输注血液制品、未静脉输液、未行血液净化时测量的HCT和血清ALB,计算HCT-ALB差值。根据入院时尿PQ快速半定量检测结果将患者分成PQ低浓度组(0~10 mg/L)和PQ高浓度组(30~100 mg/L)。分析中毒时间、中毒量以及HCT-ALB差值与急性PQ中毒程度的关系,并采用Spearman法进行等级相关性分析。结果共纳入295例急性PQ中毒患者,其中PQ低浓度组118例,PQ高浓度组177例;以及性别、年龄与PQ患者相匹配的200例健康体检者(健康对照组)。PQ低浓度组中毒时间长于PQ高浓度组〔h:11.0(6.0,60.0)比8.0(5.0,20.5),P<0.01〕,但中毒量显著低于PQ高浓度组〔mL:10.0(5.8,15.0)比40.0(20.0,80.0),P<0.01〕。PQ低浓度组和PQ高浓度组HCT、HCT-ALB差值均显著高于健康对照组〔HCT:(43.14±4.41)%、(43.54±5.40)%比(42.14±2.15)%,HCT-ALB差值:3.59±6.26、5.94±7.80比-7.26±3.55,均P<0.01〕,而ALB则显著低于健康对照组(g/L:39.54±5.74、37.60±7.15比49.40±3.41,均P<0.01)。随着尿液PQ浓度升高,HCT、HCT-ALB差值进一步升高,ALB进一步下降,PQ高浓度组与PQ低浓度组组间比较差异均有统计学意义〔HCT:(43.54±5.40)%比(43.14±4.41)%,HCT-ALB差值:5.94±7.80比3.59±6.26,ALB(g/L):37.60±7.15比39.54±5.74,均P<0.05〕。急性PQ中毒患者中毒程度与中毒时间、ALB呈负相关(r值分别为-0.195、-0.695,均P<0.01),而与中毒量、HCT、HCT-ALB差值呈正相关(r值分别为0.650、0.256、0.737,均P<0.01),其中HCT-ALB差值与中毒程度的相关性最强。结论HCT-ALB差值可反映急性PQ中毒患者的中毒程度,间接揭示急性PQ中毒患者体内微血管的病理改变。Objective To investigate the clinical values of the differences between hematocrit and serum albumin(HCT-ALB)for evaluating the severity of patients with acute paraquat(PQ)poisoning.Methods Patients with acute PQ poisoning admitted to the Second People's Hospital of Yunnan Province from January 2018 to December 2019 were enrolled,and healthy voluteers during the same period were selected as the control.The general information,poisoning dose and poisoning time of patients,as well as the HCT and serum ALB levels before blood product infusion,intravenous infusion,or hemopurification at admission were collected,and the HCT-ALB was calculated.According to the results of rapid semiquantitative test of PQ in urine at admission,the patients were divided into PQ low concentration group(0-10 mg/L)and PQ high concentration group(30-100 mg/L).The relationship between poisoning time,poisoning dose,HCT-ALB and the degree of acute PQ poisoning were analyzed,and Spearman method was used to analyze the grade correlation.Results A total of 295 patients with acute PQ poisoning were enrolled,including 118 cases in PQ low concentration group and 177 cases in PQ high concentration group,and another 200 healthy persons matched with PQ patients in gender and age(healthy control group).The poisoning time of PQ low concentration group was significantly longer than that of PQ high concentration group[hours:11.0(6.0,60.0)vs.8.0(5.0,20.5),P<0.01],but the poisoning dose was significantly lower than that of PQ high concentration group[mL:10.0(5.8,15.0)vs.40.0(20.0,80.0),P<0.01].The HCT and HCT-ALB in PQ low and high concentration groups were significantly higher than those of the healthy control group[HCT:(43.14±4.41)%,(43.54±5.40)%vs.(42.14±2.15)%,HCT-ALB:3.59±6.26,5.94±7.80 vs.-7.26±3.55,all P<0.01],but ALB was significantly lower than that of the healthy control group(g/L:39.54±5.74,37.60±7.15 vs.49.40±3.41,both P<0.01).With the increase of urine PQ concentration,the HCT and HCT-ALB further increased,and ALB further decreased.There

关 键 词：急性百草枯中毒 血细胞比容 白蛋白 血细胞比容与白蛋白差值 

分 类 号：R595.4[医药卫生—内科学]