肌红蛋白预测蜂螫伤患者发生多器官功能障碍的临床价值  

Clinical value of myoglobin in predicting multiple organ dysfunction in wasp sting patients

作　　者：汪光柱 龚伟[2] 党星波[2] 杜工亮[2] 邱健[3] 贾立斌 郑榜 李润卓 蔡祥礽 刘椰 Wang Guangzhu;Gong Wei;Dang Xingbo;Du Gongliang;Qiu Jian;Jia Libin;Zheng Bang;Li Runzhuo;Cai Xiangren;Liu Ye(Hanguang Campus,Xi’an Medical College,Xi’an 710068,China;Department of Emergency,ShaanxiProvincial People's Hospital,Xi’an 710068,China;Department of General Surgery,Shaanxi ProvincialPeople's Hospital,Xi’an 710068,China)

机构地区：[1]西安医学院含光校区,西安7100068 [2]陕西省人民医院急诊外科,西安7100068 [3]陕西省人民医院普外科,西安7100068

出　　处：《中华急诊医学杂志》2022年第3期328-333,共6页Chinese Journal of Emergency Medicine

摘　　要：目的探讨蜂螫伤致多器官功能障碍(multiple organ dysfunction syndrome,MODS)患者的临床特征及危险因素;方法采用回顾性队列研究的方法,收集2016年6月至2020年12月有明确的蜂螫伤病史及临床表现且入院第一诊断为蜂螫伤患者的资料,排除既往有血液系统疾病患者、恶性肿瘤患者、严重肝肾功能不全患者、心功能不全患者,入院前已行激素治疗患者,入院48 h内采集标本因溶血或其他原因不能得到有效实验室结果的患者。记录患者入院48 h内所取血液样本的白细胞总数(white blood cell count,WBC)、中性粒细胞绝对值(neutrophil count,NEU)、淋巴细胞绝对值(lymphocyte count,LYM)、血红蛋白计数(Hemoglobin count,HB)、肌红蛋白(myoglobin,Mb/MYO)、活化部分凝血酶原时间(activated partial thromboplastin time,APTT)、白蛋白(albumin,ALB)、血钾(K)、血钠(Na)、血氯(Cl)指标。根据住院期间是否发生MODS分为MODS组和非MODS(NMODS)组。采用单因素及多因素分析影响蜂螫伤患者住院期间发生MODS的因素,并绘制受试者工作特征(receiver operating characteristic,ROC)曲线,评估肌红蛋白水平对蜂螫伤患者住院期间发生MODS的预测效能。结果与NMODS组相比,MODS组Mb、WBC、NEU、APTT、K[分别为3890.00(1416.904057.00)ng/mL,(21.99±8.18)×10^(9)/L,(19.61±7.33)×10^(9)/L,(93.75±45.77)s,(4.99±0.95)mmol/L]明显高于NMODS组[分别为73.50(34.30264.20)ng/mL,(13.40±4.14)×10^(9)/L,(11.18±4.73)×10^(9)/L,(37.00±17.16)s,(4.05±0.56)mmol/L],两组间存在显著差异(P<0.05);Cl、ALB[分别为101.50(98.25105.00)mmol/L,(35.36±6.44)g/L]明显低于NMODS组[分别为105.00(103.00107.00)mmol/L,(40.71±5.48)g/L],两组间存在显著差异(P<0.05)。多因素Logistic回归分析显示NEU(OR=0.729,95%CI:0.542~0.981)、Mb(OR=0.999,95%CI:0.998~1.000)、APTT(OR=0.951,95%CI:0.921~0.982),是蜂螫伤患者发生MODS的独立危险因素。ROC曲线分析显示,NEU、Mb、APTT均可以作为蜂螫伤患者发生MODSObjective To investigate the clinical features and risk factors of multiple organ dysfunction syndrome(MODS)caused by wasp sting.Methods A retrospective cohort study was conducted to collect the general data of wasp sting patients who had a clear history of wasp sting disease and clinical manifestations from June 2016 to December 2020 and were fi rst diagnosed as wasp sting in hospital.Patients with hematological diseases,malignant tumors,severe liver and kidney dysfunction,cardiac insuffi ciency,and patients who had received hormone therapy before admission were excluded.Patients who were unable to obtain effective laboratory results due to hemolysis or other reasons within 48 h of admission were also excluded.The white blood cell count(WBC),neutrophil count(NEU),lymphocyte count(LYM),hemoglobin count(HB),myoglobin(Mb/MYO),activated partial thromboplastin time(APTT),albumin(ALB),K,Na,and Cl of the blood samples collected within 48 h after admission were recorded.Patients were divided into the MODS group and non-MODS group according to whether MODS occurred during hospitalization.Uni-and multivariate analysis were used to analyze the factors affecting the occurrence of MODS in wasp sting patients during hospitalization,and the receiver operating characteristic(ROC)curve was plotted to evaluate the predictive effect of myoglobin level on the occurrence of MODS in wasp sting patients during hospitalization.Results Mb,WBC,NEU,APTT and serum potassium in the MODS group[3890.00(1416.90-4057.00)ng/mL,(21.99±8.18)×10^(9)/L,(19.61±7.33)×10^(9)/L,(93.75±45.77)s,and(4.99±0.95)mmol/L]were signifi cantly higher than those in the non-MODS group[73.50(34.30-264.20)ng/mL,(13.40±4.14)×10^(9)/L,(11.18±4.73)×10^(9)/L,(37.00±17.16)s,and(4.05±0.56)mmol/L](all P<0.05);blood chlorine and ALB[(101.50(98.25-105.00)mmol/L and(35.36±6.44)g/L)]were signifi cantly lower than those in the non-MODS group[(105.00(103.00-107.00)mmol/L and(40.71±5.48)g/L)](all P<0.05).Multivariate logistic regression analysis showed that NEU(OR=0.7

关 键 词：蜂螫伤 多器官功能障碍 肌红蛋白 活化部分凝血活酶 

分 类 号：R646[医药卫生—外科学]