急性百草枯中毒预后影响因素初探  

Preliminary study on prognostic factors of acute paraquat poisoning

作　　者：苏艺伟 李广珍 刘移民[1] 王建宇[1] 张燕[1] 周丽屏[1] 王致[1] SU Yiwei;LI Guangzhen;LIU Yimin;WANG Jianyu;ZHANG Yan;ZHOU Liping;WANG Zhi(Key Laboratory of Occupational Environment and Health,Guangzhou Municipal Twelfth People's Hospital,Guangzhou,Guangdong 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,广东广州510620

出　　处：《中国工业医学杂志》2023年第1期16-19,共4页Chinese Journal of Industrial Medicine

基　　金：广东省基础与应用基础研究基金项目(编号: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(编号:202206010061);广州市医学重点学科建设项目(2021—2023年)。

摘　　要：目的探索急性百草枯(paraquat,PQ)中毒预后的影响因素,为临床早期判断PQ中毒结局提供依据。方法选取2010年1月—2019年12月在广州市第十二人民医院住院治疗且符合研究条件的226名急性PQ中毒患者,根据中毒后60 d的随访结局分为存活组(96人)和死亡组(130人),比较分析两组患者入院时的基线资料、中毒相关信息、首次血液常规指标检测结果、治疗方法和中毒结局,探索有效预测中毒结局的影响因素并拟合预测模型。结果生存组患者PQ摄入量、发生呕吐比例、激素治疗比例、血液净化比例、入院时的WBC计数、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、血糖(Glu)、血尿素(Urea)、血肌酐(Cr)值等均较死亡组低(P<0.05);Logistics回归分析显示,PQ摄入量、WBC计数、AST、Glu是影响急性PQ中毒预后的关键因素(P<0.05),联合四项指标拟合模型(R2=68.9%)预测急性PQ中毒死亡概率准确性达85.0%;受试者工作特征曲线(ROC)分析显示,四项指标在辨别急性PQ中毒预后中均具有较高的灵敏度和特异度,可独立预测中毒结局。结论PQ摄入量、WBC计数、AST、Glu是影响急性PQ中毒预后的独立危险因素,综合分析这些关键指标有助于早期判断急性PQ中毒预后。Objective To explore the influencing factors of the prognostic of acute paraquat(PQ)poisoning,thereby provide a basis for clinical early judgment of poisoning outcome.Methods Two hundred and twenty-six patients with acute PQ poisoning who were hospitalized in Guangzhou Municipal Twelfth People's Hospital from January 2010 to December 2019 and met the research conditions were selected as research objects.The patients were divided into survival group(96 people)and death group(130 people)according to the follow-up outcome on the 60th days after poisoning,then,compare and analyze the baseline data,poisoning related information,the results of the first routine blood test,treatment method and poisoning outcome of two groups of patients at the time of admission.Thereby,explore the influencing factors of poisoning outcomes and fit the prediction model.Results The results showed that the PQ intake,the proportion of vomiting,the proportion of hormone therapy,the proportion of blood purification,the white blood cell count at admission,serum levels of ALT and AST,Glu,Urea,and Cr level of the patients in the survival group were all lower than those in the death group(P<0.05);Logistics regression analysis showed that PQ intake,white blood cell count,serum aspartate aminotransferase and blood glucose were the key factors affecting the prognosis of acute PQ poisoning(P<0.05);the accuracy of the combined four-index fitting model(R2=68.9%)in predicting the death probability of acute PQ poisoning was 85.0%;the analysis of the working characteristic curve(ROC)of the subjects showed that the four indicators had high sensitivity and specificity in distinguishing the prognosis of acute PQ poisoning,and could independently predict the outcome of poisoning as well.Conclusion The results suggested that PQ intake,white blood cell count,serum aspartate aminotransferase and blood glucose were independent risk factors that affect the prognosis of acute PQ poisoning;comprehensive analysis of these key indicators was helpful to early judge the

关 键 词：百草枯 中毒 预后 影响因素 

分 类 号：R595.4[医药卫生—内科学]