早期血液检验指标联合全肺平均CT值对急性百草枯中毒患者预后的评估价值  

Prognostic value of early indicators in blood test combined with the average CT number of whole lung in patients with acute paraquat poisoning

作　　者：江信睿 卢庚 刘恒均 周家伟 邵斌霞 徐鹏[1] 王军[1] Xinrui Jiang;Geng Lu;Hengjun Liu;Jiawei Zhou;Binxia Shao;Peng Xu;Jun Wang(Department of Emergency,Nanjing Drum Tower Hospital,Medical school of Nanjing University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院急诊科,江苏南京210008

出　　处：《中华卫生应急电子杂志》2023年第5期270-277,共8页Chinese Journal of Hygiene Rescue(Electronic Edition)

基　　金：2020年度江苏省卫生健康委医学科研立项项目(ZDA2020021);南京市医药科技发展计划资助项目(ZKX18013)。

摘　　要：目的探讨早期血液检测指标联合全肺平均CT值对急性百草枯中毒患者预后的评估价值。方法回顾性分析2015年1月至2020年6月期间南京鼓楼医院急诊科收治的46例急性百草枯中毒患者的临床资料,其中死亡组男性12例,女性13例;年龄20~92岁,平均(45.36±18.56)岁;生存组男性10例,女性11例;年龄14~71岁,平均(40.52±14.33)岁。收集患者入院24 h内的血液检验指标值以及入院首次胸部HRCT的全肺平均CT值。通过二元Logistic回归分析影响急性百草枯中毒患者预后的危险因素,并绘制ROC曲线,评估其评估预后的价值。结果与生存组患者相比,死亡组患者的白细胞计数、中性粒细胞百分比、中性粒细胞计数、NLR、AST、尿素、肌酐显著升高(P<0.01),淋巴细胞百分比、淋巴细胞计数、eGFR(MDRD)则显著降低(P<0.01),而其他血液检验指标差异均无统计学意义(P>0.05)。各血液检验指标值预测急性百草枯中毒患者预后的AUC范围为0.74~0.89。与生存组患者比较,死亡组患者的全肺平均CT值更高,且差异有统计学意义(P<0.01),而全肺平均CT值预测急性百草枯中毒患者预后的AUC为0.91(95%CI0.83~1.00)。二元Logistic回归分析显示,将NLR、eGFR(MDRD)和全肺平均CT值联合预测急性百草枯中毒患者预后的效能大于单一指标,AUC为0.98(95%CI 0.95~1.00)。当三者联合的最佳临界值为-0.11时,敏感度为100%,特异度为96%,约登指数为0.96。结论白细胞计数、中性粒细胞百分比、中性粒细胞计数、淋巴细胞百分比、淋巴细胞计数、NLR、AST、尿素、肌酐、eGFR(MDRD)值及全肺平均CT值均是急性百草枯中毒患者预后的单变量预测因子,而联合分析NLR、eGFR(MDRD)和全肺平均CT值比单一指标能更准确预测百草枯中毒患者的预后。Objective To investigate the evaluation value of early blood test indexes combined with lung high resolution computed tomography(HRCT)in the prognosis of patients with acute paraquat poisoning.Methods A retrospective analysis was carried out on the clinical blood tests and chest imaging data of 46 patients with acute paraquat poisoning admitted to the emergency department of Nanjing Drum Tower hospital from January 2015 to June 2020.In the death group,there were 12 males and 13 females;the average age was(45.36±18.56)years,ranging from 20 to 92 years.In survival group,there were 10 males and 11 females,their ages ranged from 14 to 71 years,with an average age of(40.52±14.33)years.The values of blood test indexes within 24 hours and the average lung CT number of chest HRCT after admission were collected;Binary logistic regression was used to analyze the risk factors for the prognosis of patients with acute paraquat poisoning,and ROC was drawn for the risk factors to analyze its effect on the death of patients with paraquat poisoning.Results A total of 98 patients with acute paraquat poisoning were screened,and 46 patients who met the criteria were analyzed.Compared with patients in the survival group,the white blood cell count,neutrophil percentage,neutrophil count,neutrophil-to-lymphocyte ratio,AST,urea,creatinine of patients in the death group were significantly increased(P<0.01),lymphocyte percentage and lymphocyte count,EGFR(MDRD)were significantly reduced(P<0.01),but there was no significant difference in other blood test indexes(P>0.05).The AUC of blood test index values ranged from 0.74 to 0.89.Compared with the survival group,the average CT number of whole lung in the death group was higher,and the difference was statistically significant(P<0.001)with an AUC of 0.91(95%CI 0.83~1.00).Binary logistic regression analysis showed that the combination of NLR,eGFR(MDRD)and the average CT number of whole lung was more effective than a single index in predicting the prognosis of patients with acute paraquat poiso

关 键 词：百草枯 肺损伤 血液检验指标 HRCT 预后 

分 类 号：R595.4[医药卫生—内科学]