血浆肾上腺髓质素前体N端20肽对急性有机磷农药中毒患者继发心肌损害预测价值  

Predictive value of plasma adrenomedullin precursor N-terminal 20 peptide for secondary myocardial damage in patients with acute organophosphorus pesticide poisoning

作　　者：周怡 孙成东 丁玲 王言理[1] ZHOU Yi;SUN Chengdong;DING Ling;WANG Yanli(Emergency Department,Lianyungang First People's Hospital,Lianyungang Jiangsu 222000,China)

机构地区：[1]连云港市第一人民医院急诊科,江苏连云港222000

出　　处：《中国急救复苏与灾害医学杂志》2022年第10期1344-1347,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：江苏省卫生计生委2015年度面上科研课题(编号:H201527)。

摘　　要：目的探讨血浆肾上腺髓质素前体N端20肽(PAMP)对急性有机磷农药中毒患者继发心肌损害的预测价值。方法选取2018年3月—2021年3月连云港市第一人民医院收治的106例急性有机磷农药中毒患者,另选取同期医院收治的95例健康体检者。采用电化学发光双抗体夹心法检测急性有机磷农药中毒患者和健康体检者血浆PAMP水平,检测血清肌钙蛋白水平以帮助诊断继发性心肌损伤。统计急性有机磷农药中毒患者继发心肌损害发生情况,比较发生继发心肌损害患者与未发生患者临床特征,采用Logistic回归分析判定影响急性有机磷农药中毒患者继发心肌损害的因素,采用受试者工作曲线(ROC)分析血浆PAMP水平,预测急性有机磷农药中毒患者继发心肌损害的价值。结果急性有机磷农药中毒患者血浆PAMP水平高于健康体检者(P<0.05);急性有机磷农药中毒患者继发心肌损害发生率为33.02%;发生继发心肌损害患者性别、吸烟史、饮酒史、高血压、糖尿病、冠心病的构成比以及年龄、中毒至入院时间、入院时血浆药物浓度、哥斯拉昏迷评分、心率、肌酸激酶、肌酸激酶同工酶、肌酐、尿素氮、乳酸脱氢酶水平与未发生患者比较,差异均无统计学意义(P>0.05);发生继发心肌损害患者心律失常构成比以及肌钙蛋白、血浆PAMP水平与未发生患者比较,差异均有统计学意义(P<0.05);Logistic多因素回归分析显示PAMP、肌钙蛋白均是急性有机磷农药中毒患者继发心肌损害的独立危险因素(P<0.05);ROC分析显示,血浆PAMP水平预测急性有机磷农药中毒患者继发心肌损害的最佳截断点为7.88 pg/mL,灵敏度为88.57%,特异度为95.77%,曲线下面积(AUC)为0.920。结论急性有机磷农药中毒患者血浆PAMP水平异常升高,且发生继发心肌损害患者血浆PAMP水平高于未发生患者,血浆PAMP水平可作为预测急性有机磷农药中毒患者继发心肌损害ObjectiveTo explore the predictive value of plasma pro-adrenomedullin N-terminal 20 peptide(PAMP)in patients with acute organophosphorus pesticide poisoning secondary to myocardial damage.Methods106 patients with acute organophosphorus pesticide poisoning admitted to the hospital from March 2018 to March 2021 and 95health examination patients admitted to the hospital during the same period were selected.The electrochemiluminescence double antibody sandwich method was used to detect plasma PAMP levels in patients with acute organophosphorus pesticide poisoning and healthy subjects.Serum level of troponin was tested to help diagnose secondary myocardial damage.Logistic regression analysis was used to determine the factors affecting secondary myocardial damage in patients with acute organophosphorus pesticide poisoning,and receiver operating curve(ROC)was used to analyze value of plasma PAMP level in predicting secondary myocardial damage in those patients.Results Plasma PAMP level of patients with acute organophosphorus pesticide poisoning was significantly higher than that of the healthy physical examinees(P<0.05).The incidence of secondary myocardial damage in the patients with acute organophosphorus pesticide poisoning was 33.02%.There were no significant differences in gender,age,smoking history,drinking history,histories of hypertension,diabetes,and coronary heart disease,time from poisoning to hospital admission,plasma drug concentration at admission,Godzilla coma score,heart rate,levels of creatine kinase,creatine kinase isoenzyme,creatinine,urea nitrogen,lactate dehydrogenase between the patients with and without secondary myocardial damage(all P>0.05).The arrhythmia composition ratio,troponin and plasma PAMP level of the patients with secondary myocardial damage were all significantly higher than those of the patients without secondary myocardial damage(all P<0.05).Logistic multivariate regression analysis showed that PAMP and troponin levels were both independent risk factors for secondary myocardial dama

关 键 词：急性有机磷农药中毒 肾上腺髓质素前体N端20肽 心肌损害 预测 

分 类 号：R595[医药卫生—内科学]