鹅膏菌中毒患者临床指标和肝衰竭预后相关评分与预后的关联分析  

Correlation analysis of clinical indicators and liver failure-related prognostic score associated with prognosis in patients with amanita phalloides poisoning

作　　者：梁晓丽 刘善收 王冰玥 赵霄君 段楚君 虎晓岷 谢建刚 Liang Xiaoli;Liu Shanshou;Wang Bingyue;Zhao Xiaojun;Duan Chujun;Hu Xiaomin;Xie Jian'gang(Department of Emergency,Xijing Hospital,Air Force Medical University,Xi'an 710032,Shaanxi,China;Shihezi University,Shihezi 832061,Xinjiang Uygur Autonomous Region,China)

机构地区：[1]空军军医大学附属西京医院急诊科,陕西西安710032 [2]石河子大学,新疆维吾尔自治区石河子832061

出　　处：《中华危重病急救医学》2022年第11期1178-1182,共5页Chinese Critical Care Medicine

基　　金：陕西省自然科学基础研究计划项目(2020JQ-466)。

摘　　要：目的分析并比较不同预后鹅膏菌中毒患者的临床指标和肝衰竭预后相关评分,寻找潜在预后指标。方法采用回顾性病例对照研究方法,收集2016年9月至2021年9月空军军医大学附属西京医院急诊科收治的52例鹅膏菌中毒患者的临床资料。收集患者的一般资料(性别、年龄)、入院时的临床指标〔平均动脉压(MAP)、总胆红素(TBil)、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、白蛋白(ALB)、血肌酐(SCr)、血尿素氮(BUN)、肌酸激酶(CK)、D-二聚体、纤维蛋白原降解产物(FDP)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶原活动度(PTA)、国际标准化比值(INR)、白细胞计数(WBC)、血小板计数(PLT)〕和肝衰竭预后相关评分〔序贯器官衰竭评分(SOFA)、慢性肝衰竭(CLIF)-SOFA评分、欧洲慢性肝衰竭研究基金会器官衰竭评分(CLIF-C OF)〕,以及28 d预后。比较不同预后患者的一般资料、临床指标和肝衰竭预后相关评分;利用受试者工作特征曲线(ROC曲线)判断不同预后两组患者间差异有统计学意义的指标对鹅膏菌中毒患者预后的预测价值。结果最终共45例患者纳入分析,其中28 d存活38例,死亡7例。死亡组患者凝血指标PT、APTT、INR及肝衰竭预后相关评分SOFA、CLIF-SOFA、CLIF-C OF均明显高于存活组〔PT(s):69.59±15.94比25.99±4.64,APTT(s):83.44±17.82比42.64±3.79,INR:6.13±1.47比2.07±0.33,SOFA评分(分):11.57±1.38比6.03±0.77,CLIF-SOFA评分(分):9.86±2.17比5.55±0.67,CLIF-C OF评分(分):11.71±0.97比8.37±0.35〕,PLT明显低于存活组(×10^(9)/L:80.57±29.65比169.60±11.80),差异均有统计学意义(均P<0.05);而两组一般资料及其他临床指标和肝衰竭预后相关评分差异均无统计学意义。ROC曲线分析显示,凝血指标PT、APTT、INR、PLT和肝衰竭预后相关评分SOFA、CLIF-C OF对鹅膏菌中毒患者预后均有一定预测价值,ROC曲线下面积(AUC)均>0.75。凝血指标的敏感�Objective To analyze and compare the clinical indicators and the liver failure-related prognostic score of patients with amanita phalloides poisoning with different prognoses,and to explore potential prognostic indicators.Methods A retrospective case-control study was conducted.The clinical data of 52 patients with amanita phalloides poisoning admitted to the department of emergency of Xijing Hospital Affiliated to Air Force Medical University from September 2016 to September 2021 were collected,including general information(gender,age),clinical indicators at admission[mean arterial pressure(MAP),total bilirubin(TBil),aspartate transaminase(AST),alanine transaminase(ALT),albumin(ALB),serum creatinine(SCr),blood urea nitrogen(BUN),creatine kinase(CK),D-dimer,fibrinogen degradation product(FDP),prothrombin time(PT),activated partial thromboplastin time(APTT),prothrombin activity(PTA),international normalized ratio(INR),white blood cell count(WBC),platelet count(PLT)],liver failure-related prognostic score[sequential organ failure assessment(SOFA),chronic liver failure(CLIF)-SOFA score,European Foundation for the Study of Chronic Liver Failure-organ failure(CLIF-C OF)],and 28-day outcome.The clinical indicators and liver failure-related prognostic scores of the patients with different prognoses were compared.Receiver operator characteristic curve(ROC curve)was used to determine the prognostic value of statistically significant indicators between different prognosis of patients with amanita poisoning.Results A total of 45 patients were enrolled,of which 38 survived and 7 died within 28 days.The coagulation indicators including PT,APTT,INR,and liver failure-related prognostic scores including SOFA score,CLIF-SOFA score,and CLIF-C OF score in the patients of death group were significantly higher than those in the survival group[PT(s):69.59±15.94 vs.25.99±4.64,APTT(s):83.44±17.82 vs.42.64±3.79,INR:6.13±1.47 vs.2.07±0.33,SOFA score:11.57±1.38 vs.6.03±0.77,CLIF-SOFA score:9.86±2.17 vs.5.55±0.67,CLIF-C OF score:1

关 键 词：鹅膏菌中毒 预后 肝衰竭评分 

分 类 号：R595.7[医药卫生—内科学] R575.3[医药卫生—临床医学]