秋水仙碱中毒患者的临床特点及危险因素分析  

Clinical characteristics and prognostic risk factors of patients with colchicine poisoning

作　　者：李佳佳[1,2] 唐亚慧 吴丹阳[1] 陈潇荣 陈隆望 吴斌[1] 赵光举[1] 卢中秋[1,2] Li Jiajia;Tang Yahui;Wu Danyang;Chen Xiaorong;Chen Longwang;Wu Bin;Zhao Guangju;Lu Zhongqiu(Department of Emergency Medicine,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China;Wenzhou Key Laboratory of Emergency and Disaster Medicine,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第一医院急诊科,温州325000 [2]温州市急危重病与救援医学重点实验室,温州325000

出　　处：《中华急诊医学杂志》2023年第2期210-214,共5页Chinese Journal of Emergency Medicine

基　　金：国家重点研发计划项目(2018YFC2000305);温州市科技计划项目(Y2020092);温州市重大科技创新攻关项目(ZY2022023)。

摘　　要：目的探究秋水仙碱中毒患者临床特点,分析影响秋水仙碱中毒预后的危险因素及其在预后评估中的价值。方法回顾性纳入2017年12月至2022年10月在温州医科大学附属第一医院急诊重症监护室收住的秋水仙碱中毒患者,根据14 d的结局分为生存组和死亡组;比较两组患者的一般情况,分析秋水仙碱中毒患者临床特点;比较两组患者入院首次实验室指标、心电图、心超等临床指标的差异,探讨其在秋水仙碱中毒患者预后评估中的价值。结果秋水仙碱中毒患者共41例,年龄15~85岁,其中男性35例,女性6例;生存组27例(65.9%),死亡组14例(34.1%);蓄积中毒(58.7%),自杀中毒(41.3%)。秋水仙碱中毒患者主要临床表现为消化道症状(82.93%)、多器官功能不全(78.05%)、感染性发热(73.17%)、心肌损害(48.78%)、凝血功能障碍(46.34%)、骨髓抑制(41.46%),部分患者出现肠梗阻(19.51%)、横纹肌溶解(2.44%)等。将单因素分析中差异具有统计学意义的指标纳入多因素Logistic回归分析,其中QTc间期、乳酸、凝血酶原时间、D二聚体、碱性磷酸酶绝对值升高是秋水仙碱中毒患者预后的危险因素(OR=1.028,95%CI:1.000~1.056;OR=1.599,95%CI:1.088~2.350;OR=1.205,95%CI:1.002~1.450;OR=1.242,95%CI:1.242,95%CI:1.089~1.417;OR=1.013,95%CI:1.002~1.024);ADL评分、间接胆红素绝对值下降是秋水仙碱中毒患者预后的保护因素(OR=0.947,95%CI:0.909~0.988;OR=0.756,95%CI:0.572~0.999),差异具有统计学意义(P<0.05)。D二聚体[AUC(曲线下面积,area under curve)=0.913]、乳酸(AUC=0.875)、碱性磷酸酶(AUC=0.770)对秋水仙碱中毒患者预后具有预测价值,其截断值分别为8.965 mg/L、4.05 mmol/L、230.5 U/L。结论秋水仙碱中毒患者入院时已出现多器官功能不全,病情危重,早期D二聚体及乳酸、碱性磷酸酶水平能有效预测秋水仙碱中毒患者预后。Objective To explore the clinical characteristics of patients with colchicine poisoning,and analyze the risk factors affecting the prognosis of colchicine poisoning and its value in the prognostic assessment.Methods Patients with colchicine poisoning admitted to the Emergency Intensive Care Unit of the First Affiliated Hospital of Wenzhou Medical University from December 2017 to October 2022 were retrospectively included and divided into the survival group and death group according to the 14-d outcome.The general conditions of the two groups of patients were compared,and the clinical characteristics of patients with colchicine poisoning were analyzed.The differences of laboratory indexes,electrocardiogram,cardiac ultrasound and other clinical indexes during the first admission of patients between the two groups were compared,and their value in the prognosis evaluation of patients with colchicine poisoning was explored.Results There were 41 patients with colchicine poisoning,aged 15-85 years,including 35 males and 6 females.There were 27 patients(65.9%)in the survival group and 14 patients(34.1%)in the death group,including accumulative poisoning(58.7%)and suicide poisoning(41.3%).The main clinical manifestations of patients with colchicine poisoning were gastrointestinal symptoms(82.93%),multiple organ dysfunction(78.05%),infectious fever(73.17%),myocardial damage(48.78%),coagulation dysfunction(46.34%),and bone marrow suppression(41.46%).Intestinal obstruction(19.51%)and rhabdomyolysis(2.44%)occurred in some patients.Multivariate Logistic regression analysis showed that the increase in absolute value of QTc interval(OR=1.028,95%CI:1.000~1.056,P<0.05),lactic acid(OR=1.599,95%CI:1.088~2.350,P<0.05),prothrombin time(OR=1.205,95%CI:1.002~1.450,P<0.05),D-dimer(OR=1.242,95%CI:1.089~1.417,P<0.05),and alkaline phosphatase(OR=1.013,95%CI:1.002~1.024,P<0.05)were the risk factors for the prognosis of patients with colchicine poisoning.The decrease in the absolute value of ADL score(OR=0.947,95%CI:0.909~0.988,P<0.05)and ind

关 键 词：秋水仙碱中毒 流行病学 临床表现 危险因素 预后 D二聚体 乳酸 碱性磷酸酶 多器官功能不全 骨髓抑制 

分 类 号：R595[医药卫生—内科学]