蘑菇中毒导致心肌损伤的危险因素分析及预测模型构建与验证  

Analysis of risk factors for myocardial injury caused by mushroom poisoning and the construction and verification of prediction model

作　　者：胡聪龙 傅泽辉 尹礼义 刘轶群 曹彦[1] 韩小彤[1] Hu Conglong;Fu Zehui;Yin Liyi;Liu Yiqun;Cao Yan;Han Xiaotong(Emergency Department,Hunan Provincial People′s Hospital(the First Affiliated Hospital of Hunan Normal University)&Clinical Research Center for Emergency and Critical Care in Hunan Province&Hunan Provincial Institute of Emergency Medicine&Hunan Provincial Key Laboratory of Emergency and Critical Care Metabonomics,Changsha 410000,China)

机构地区：[1]湖南省人民医院(湖南师范大学附属第一医院)急诊医学科、湖南省急危重症临床医学研究中心、湖南省急救医学研究所、急危重症代谢组学湖南省重点实验室,湖南长沙410000 [2]贵港市平南县人民医院急诊医学科,广西贵港537300

出　　处：《中国急救医学》2024年第7期572-576,共5页Chinese Journal of Critical Care Medicine

基　　金：湖南省自然科学基金(2024JJ9160);湖南省急危重症临床医学研究中心资助课题(2021SK4011)。

摘　　要：目的 回顾性分析蘑菇中毒患者发生心肌损伤的危险因素并构建与验证预测模型。方法 将2012年7月至2023年9月湖南省人民医院和广西壮族自治区贵港市平南县人民医院收治的蘑菇中毒患者211例,根据中毒后有无心肌损伤情况分为两组,比较两组中毒患者的一般资料、心肌酶谱、心电图等情况,采用单因素和多因素回归分析蘑菇中毒患者发生心肌损伤的危险因素,并据此构建与验证危险因素预测模型。结果 单因素分析显示,心肌损伤组患者乳酸脱氢酶、肌酸激酶、肌酸激酶同工酶、肌红蛋白、肌钙蛋白Ⅰ、心电图异常均高于非心肌损伤组患者(P均<0.05),血红蛋白、血钙均低于非心肌损伤组患者(P均<0.05)。多因素回归分析结合ROC曲线分析表明,肌红蛋白、肌钙蛋白Ⅰ水平升高,血钙水平降低,以及心电图异常是蘑菇中毒导致心肌损伤的独立危险因素。通过Hosmer-Lemeshow检验,模型的内部一致性良好,拟合优度高(P>0.05)。结论 肌红蛋白、肌钙蛋白Ⅰ、血钙、心电图异常是预测蘑菇中毒导致心肌损伤的重要因素。在临床实践中,应重视高危因素的识别,监测相关指标,并及时采取干预治疗,以促进患者康复。Objective To retrospectively analyze the risk factors for myocardial injury in mushroom poisoning patients and construct and validate a prediction model.Methods A total of 211 mushroom poisoning patients admitted to Hunan Provincial People′s Hospital and Pingnan County People′s Hospital of Guangxi Zhuang Autonomous Region from July 2012 to September 2023 were divided into two groups according to whether they had myocardial injury after poisoning.The general information,myocardial enzyme spectrum,electrocardiogram of the poisoning patients in the two groups were compared.The risk factors for myocardial injury in mushroom poisoning patients were analyzed by univariate and multivariate regression analysis,and a prediction model of risk factor was constructed and validated based on the results.Results Univariate analysis showed that the levels of lactate dehydrogenase,creatine kinase,creatine kinase isoenzyme,myoglobin,cardiac troponin I and electrocardiogram abnormalities were higher in the myocardial injury group than in the non-myocardial injury group(P<0.05),while the levels of hemoglobin and blood calcium were lower in the myocardial injury group with statistically significant differences(P<0.05).Multivariate regression analysis combined with receiver operating characteristic(ROC)curve showed that elevated myoglobin and cardiac troponin I levels,low blood calcium levels,and electrocardiogram abnormalities were independent risk factors for myocardial injury induced by mushroom poisoning.The Hosmer-Lemeshow test showed that the model had good internal consistency and high goodness of fit(P>0.05).Conclusions Myoglobin,cardiac troponin I,blood calcium and electrocardiogram are important predictors of myocardial injury caused by mushroom poisoning.In clinical practice,it is important to identify high-risk factors,monitor relevant indicators,and take timely interventional treatment to promote patients′recovery.

关 键 词：蘑菇中毒 心肌损伤 危险因素 预测模型 肌红蛋白 肌钙蛋白Ⅰ 血钙 心电图 

分 类 号：R595[医药卫生—内科学]