百草枯中毒剂量和尿蛋白及心肌酶的风险预测价值  

The risk prediction value of paraquat poisoning dose,urine protein and myocardial enzymes

作　　者：苏艺伟 刘移民[1] 张晋蔚 周丽屏[1] 杜伟佳[1] 王致[1] Su Yiwei;Liu Yimin;Zhang Jinwei;Zhou Liping;Du Weijia;Wang Zhi(Key Laboratory of Occupational Environment and Health,Guangzhou Twelfth People's Hospital,Guangzhou 510620,China)

机构地区：[1]广州市第十二人民医院职业环境与健康重点实验室,广州510620

出　　处：《中华劳动卫生职业病杂志》2023年第1期8-13,共6页Chinese Journal of Industrial Hygiene and Occupational Diseases

基　　金：广东省基础与应用基础研究基金联合基金项目(2021A1515110663);广州市高水平临床重点专科建设项目(穗卫函(2019)1555号);广州市科学技术局重点研发计划项目(202206010061);广州市医学重点学科建设项目(2021-2023年)。

摘　　要：目的探讨百草枯(PQ)摄入量、尿蛋白及心肌酶指标在判断急性PQ中毒患者预后中的价值。方法于2021年9至12月,选取2010年1月至2019年12月广州市第十二人民医院收治的201例急性PQ中毒患者为研究对象,根据中毒后60 d的随访结果,将研究对象分成存活组(78例)和死亡组(123例)。分析两组患者中毒信息、治疗方案、PQ摄入量、尿蛋白、肌酸激酶、肌酸激酶同工酶、乳酸脱氢酶、α-羟丁酸脱氢酶等资料的差异性,用logistic回归和Cox回归分析中毒结局与PQ摄入量、尿蛋白和各心肌酶指标之间的关联,用ROC曲线和主成分分析探索高效能预测急性PQ中毒结局的指标。结果死亡组患者的PQ摄入量[50(20,100)ml]、尿蛋白(总秩次为15570.50)、肌酸激酶[(336.36±261.96)U/L]、肌酸激酶同工酶[(43.91±43.74)U/L]、乳酸脱氢酶[(346.01±196.50)U/L]、α-羟丁酸脱氢酶含量[(271.23±11.92)U/L]均高于存活组[分别为15(10,20)ml、4730.50、(187.78±178.06)U/L、(18.88±15.50)U/L、(190.92±60.50)U/L、(152.60±48.34)U/L](P<0.05)。急性PQ中毒结局与PQ摄入量、尿蛋白、肌酸激酶、肌酸激酶同工酶、乳酸脱氢酶、α-羟丁酸脱氢酶均呈正向关联(P<0.05)。多因素logistic回归和多因素Cox回归分析显示,肌酸激酶、肌酸激酶同工酶、乳酸脱氢酶、α-羟丁酸脱氢酶与急性PQ中毒患者预后均呈正向关联(P<0.05)。ROC曲线和主成分分析显示,PQ摄入量、尿蛋白和各心肌酶联合指标在判断患者预后的效能和权重最高(AUC=0.91,权重系数=0.19,灵敏度=0.76,特异度=0.89);当联合得分≥4分时,准确预测患者死亡的概率为91%(阳性预测值=0.91)。结论PQ摄入量、尿蛋白联合肌酸激酶、肌酸激酶同工酶、乳酸脱氢酶、α-羟丁酸脱氢酶判断急性PQ中毒患者预后具有较高的价值。Objective To explore the value of paraquat(PQ)intake,urine protein and myocardial enzyme indexes in judging the prognosis of patients with acute PQ poisoning.Methods From September to December 2021,all 201 patients with acute PQ poisoning admitted to Guangzhou Twelfth People's Hospital from January 2010 to December 2019 were selected as the research objects.Based on follow-up results 60 days after poisoning,the research objects were divided into survival group(n=78)and death group(n=123).The differences in information about poisoning,treatment plan,PQ intake,urine protein,creatine kinase,creatine kinase isoenzyme,lactate dehydrogenase,andα-hydroxybutyrate dehydrogenase between the two groups of patients were compared and analyzed.Logistic regression and Cox regression were used to analyze the correlation between poisoning outcome and PQ intake,urine protein and myocardial enzymes.ROC curve and principal component analysis were used to explore high-efficiency indicators for predicting the outcome of acute PQ poisoning.Results The PQ intake[50(20,100)ml],urine protein(total rank 15570.50),creatine kinase[(336.36±261.96)U/L],creatine kinase isoenzyme[(43.91±43.74)U/L],lactate dehydrogenase[(346.01±196.50)U/L],α-hydroxybutyrate dehydrogenase content[(271.23±11.92)U/L]of patients in the death group were all higher than the survival group[15(10,20)ml,4730.50,(187.78±178.06)U/L,(18.88±15.50)U/L,(190.92±60.50)U/L,(152.60±48.34)U/L,respectively](P<0.05).The outcome of acute PQ poisoning was positively correlated with PQ intake,urine protein,creatine kinase,creatine kinase isoenzyme,lactate dehydrogenase,andα-hydroxybutyrate dehydrogenase(P<0.05).Multivariate logistic regression and multivariate Cox regression analysis showed that creatine kinase,creatine kinase isoenzyme,lactate dehydrogenase andα-hydroxybutyrate dehydrogenase was positively correlated with the prognosis of patients with acute PQ poisoning(P<0.05).ROC curve analysis and principal component analysis showed that the combined indexes of PQ intake

关 键 词：百草枯 口服 中毒 尿蛋白 心肌酶 预后 

分 类 号：R595.4[医药卫生—内科学]