不明原因凝血功能障碍患者溴敌隆中毒的危险因素  

Risk factors of bromadiolone poisoning in the patients with unexplained coagulation dysfunction

作　　者：郑艾宜 唐时元[1] 姚蓉[1] Zheng Aiyi;Tang Shiyuan;Yao Rong(Emergency Department,West China Hospital of Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院急诊科,四川成都610041

出　　处：《中国急救医学》2024年第7期598-602,共5页Chinese Journal of Critical Care Medicine

基　　金：四川省科技厅重点研发项目(2022YFS0273);成都市科技局重大科技应用示范项目(2022-YF09-00021-SN)。

摘　　要：目的 探讨不明原因凝血功能障碍患者中溴敌隆中毒的临床特征及危险因素。方法 回顾性分析2018年1月1日至2023年12月31日就诊于四川大学华西医院急诊科的不明原因凝血功能障碍患者,按时间分为建模组(n=254)和验证组(n=44),建模组根据血清溴敌隆检测结果分为溴敌隆阳性组(n=53)和阴性组(n=201),比较两组基本特征、出血部位,就诊时血常规、肝肾功能、凝血、电解质指标等,通过Lasso回归、多因素Logistic回归分析相关危险因素,进行建模并验证。结果 共纳入不明原因凝血功能障碍患者298例,其中溴敌隆阳性53例(20.87%)。Logistic回归分析显示,溴敌隆中毒患者就诊时皮肤及软组织出血、呼吸系统出血、泌尿生殖道出血、凝血酶时间缩短和D-二聚体降低是不明原因凝血功能障碍患者溴敌隆中毒的危险因素(P均<0.05)。结论 溴敌隆中毒是急诊不明原因凝血功能障碍的重要原因,就诊时皮肤及软组织出血、呼吸系统出血、泌尿生殖道出血、凝血酶时间缩短、D-二聚体降低的患者尤其需要警惕溴敌隆中毒可能,建议尽早进行血药浓度筛查。Objective To explore the clinical features and risk factors of bromadiolone poisoning in the patients with unexplained coagulation dysfunction in order to provide the references for early diagnosis.Methods A retrospective research was conducted.The patients with unexplained coagulation dysfunction who visited to the emergency department of West China Hospital of Sichuan University from January 1,2018 to December 31,2023 were selected as the study subjects,and were divided into modeling group(n=254)and validation group(n=44)according to time.According to the results of bromadiolone detection,the patients were divided into bromadiolone positive group(n=53)and bromadiolone negative group(n=201).The basic features,bleeding site,laboratory findings(blood routine test,liver and kidney function,coagulation function and electrolyte indexes)were compared between the two groups.Then,the risk factors were analyzed by Lasso regression and multivariate Logistic regression analysis,and the model was established and verified.Results A total of 298 cases were included,of which 53 cases(20.87%)with bromadiolone detection were positive.Logistic regression analysis results showed that the skin and soft tissue bleeding,hemorrhage in respiratory system,urogenital tract bleeding,shortened thrombin time and D-dimer reduction were risk factors of bromadiolone poisoning in the patients with unexplained coagulation dysfunction(P<0.05).Conclusions Bromadiolone poisoning is a common cause of unexplained coagulation dysfunction in emergency department.Patients with the skin and soft tissue bleeding,hemorrhage in respiratory system,urogenital tract bleeding,shortened thrombin time and D-dimer reduction should be especially alert to the possibility of bromadiolone poisoning,and is strongly recommended to undergo blood drug concentration screening.

关 键 词：凝血功能障碍 溴敌隆中毒 出血 危险因素 D-二聚体 凝血酶时间 

分 类 号：R595[医药卫生—内科学]