基于倾向性评分匹配的血液净化联合乌司他丁治疗急性百草枯中毒的临床疗效  

Clinical efficacy of blood purification combined with ulinastatin in the treatment of acute paraquat poisoning based on propensity score matching

作　　者：刘宏宇[1] 张萌[1] 刘振宁[1] LIU Hongyu;ZHANG Meng;LIU Zhenning(Department of Emergency,Shengjing Hospital of China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院急诊科,沈阳110004

出　　处：《中国医科大学学报》2022年第6期538-542,共5页Journal of China Medical University

摘　　要：目的 探讨血液净化联合乌司他丁治疗急性百草枯中毒的临床疗效。方法 选取2012年10月至2020年7月我院急诊科收治的急性百草枯中毒患者392例。按照治疗方法分为常规组(采用常规治疗,对症治疗基础上进行血液灌流、血液滤过治疗)和联合组(在常规治疗基础上联合乌司他丁注射治疗)。运用倾向性评分匹配(PSM)法对常规组和联合组患者进行1∶1匹配,使组间基线均衡。比较2组患者血清中肿瘤坏死因子-α (TNF-α)、白细胞介素(IL)-6、IL-10、Ⅳ型胶原蛋白(C-Ⅳ)、血管细胞间黏附分子-1 (ICAM-1)、基质金属蛋白酶-9 (MMP9)、Ⅰ型前胶原C-端肽(PⅠCP)和超氧化物歧化酶(SOD)水平,疗效及并发症发生情况。结果 与常规组比较,联合组患者血清TNF-α、IL-6、IL-10、C-Ⅳ、ICAM-1、MMP-9、PⅠCP水平显著降低,而SOD水平显著升高,差异均有统计学意义(均P <0.05)。与常规组(56.45%)比较,联合组病死率(38.70%)显著降低(P <0.05)。并发症发生情况,与常规组比较,联合组肺纤维化发生率,肝、肾等器官功能损害发生率均明显降低(均P <0.05)。结论 血液净化联合乌司他丁治疗急性百草枯中毒疗效显著,可改善患者肺、肝、肾等脏器功能,降低死亡风险。Objective To investigate the clinical efficacy of blood purification combined with ulinastatin in the treatment of acute paraquat poisoning. Methods From October 2012 to July 2020,392 patients with acute paraquat poisoning admitted in the emergency department of our hospital were selected. According to the treatment methods,the patients were divided into the conventional group(conventional treatment,including hemoperfusion and hemofiltration on the basis of symptomatic treatment) and the combined group(ulinastatin injection on the basis of conventional treatment). Propensity score matching(PSM) was used to match the patients in the conventional and combined groups at 1 ∶ 1 ratio to achieve the baseline balance between the groups. The curative effect,complications and serum levels of tumor necrosis factor(TNF)-α,interleukin(IL)-6,IL-10,collagen Ⅳ (C-Ⅳ),intercelluar adhesion molecule(ICAM)-1,matrix metalloprotein-9(MMP-9),procollagen Ⅰ C-termial propeptide(PⅠCP),and superoxide dismutase(SOD) in the two groups were compared.Results Compared to the conventional group,serum levels of TNF-α,IL-6,IL-10,C-Ⅳ,ICAM-1,MMP-9,and PⅠCP in the combined group were significantly decreased,while the SOD level was significantly increased,and the differences were statistically significant(all P < 0.05). The fatality rate in the combined group(38.70%) was significantly lower than that in the conventional group(56.45%). In terms of complications,the incidence of pulmonary fibrosis,liver,kidney,and other organ function damage in the combined group was significantly lower than that in the conventional group(all P < 0.05). Conclusion Blood purification,combined with ulinastatin is effective in the treatment of acute paraquat poisoning,which can improve the function of lung,liver,kidney and other organs and reduce the risk of death.

关 键 词：血液净化 乌司他丁 急性百草枯中毒 倾向性评分匹配 

分 类 号：R459.7[医药卫生—急诊医学]