SIRI评分对急性百草枯中毒患者不良预后的预测价值研究  

Prognostic value of system inflammation response index in patients with acute paraquat poisoning

作　　者：张天山 刘星雨 唐郭 杨莎 杨莹 姚蓉[1] ZHANG Tianshan;LIU Xingyu;TANG Guo;YANG Sha;YANG Ying;YAO Rong(Department of Emergence,West China Hospital,Sichuan University,Chengdu 610041,China;West China Clinical College,Sichuan University,Chengdu 610041,China;The Second Affiliated Hospital of Chengdu Medical College,Nuclear Industry 416 Hospital,Chengdu 610041,China)

机构地区：[1]四川大学华西医院急诊科,四川成都610041 [2]四川大学华西临床医学院,四川成都610041 [3]成都医学院第二附属医院·核工业416医院,四川成都610041

出　　处：《西部医学》2024年第12期1761-1766,1772,共7页Medical Journal of West China

基　　金：国家自然科学基金面上项目(82072156)。

摘　　要：目的通过分析急性百草枯(PQ)中毒患者的临床特征及院内预后情况,在常见的系统炎症标记物中筛选出与预后不良相关的最佳指标并探究其对急性PQ中毒患者院内死亡的预测价值。方法回顾性分析2010年9月1日—2022年1月31日期间就诊于四川大学华西医院急诊科的急性PQ中毒患者的一般资料、就诊时的实验室检查结果及院内预后,根据院内结局分为死亡组与存活组,采用受试者工作特征曲线(ROC)筛选患者院内死亡显著相关的炎症指标,为临床早期判断不同特征患者的预后提供参考。结果共纳入452例急性PQ中毒患者,其中男性207例(45.80%),平均年龄30.00(22.75,43.00)岁。452例患者中,180例在院内死亡。死亡组患者年龄、就诊时的中性粒细胞与淋巴细胞比值(NLR)、白细胞与淋巴细胞比值(WLR)、系统炎症反应指数(SIRI)均显著高于存活组(P<0.05),其中SIRI、LMR、WLR、NLR及SII预测患者院内死亡的ROC曲线下面积(AUC)分别为73.29%、63.16%、59.92%、59.81%及58.84%,均高于快速序贯器官衰竭(qSOFA)评分(56.07%)(P<0.05)。亚组分析显示SIRI对年龄14~17岁及中毒至就诊时间6~11 h的PQ中毒患者院内死亡预测的AUC均高于80%(AUC_(<18岁)=86.25%,AUC_(6~11)h=84.13%)。结论就诊时的SIRI可用于评估急性PQ中毒患者院内死亡风险,尤其是在年龄14~17岁或病程为6~11 h的人群中预测效能较佳。Objective To summarize clinical feature and prognosis of patients with acute paraquat(PQ)poisoning and analyze the predictive performance of NLR(Neutrophil-to-Lymphocyte Ratio),PLR(Platelet-to-Lymphocyte Ratio),LMR(Lymphocyte to Monocyte Ratio),WLR(Platelet-to-Lymphocyte Ratio),SIRI(System Inflammation Response Index)and SII(Systemic Immune Inflammation Index)for in-hospital death.Methods General information,laboratory examination and prognosis of acute PQ poisoning patients were retrospectively collected and analyzed from whom admitted to emergency department of West China Hospital from September 1,2010 to January 31,2022.Patients with acute PQ poisoning were divided into survival group or non-survival group according to their in-hospital outcome.The risk factors of death in hospital were screened by receiver operating characteristic curve(ROC).Results A total of 452 patients with acute PQ poisoning were enrolled,of which 207(45.80%)were males,with an average age of 30(22.75,43.00).180 patients died in hospital.Compared with the survival group,the levels of age,NLR,WLR,SIRI at admission in the non-survival group were significantly increased(P<0.05).The ROC showed that the area under the curve(AUC)of SIRI,LMR,WLR,NLR and SII were 73.29%,63.16%,59.92%,59.81%and 58.84%,which were greater than that of qSOFA score(56.07%,P<0.05).Subgroup analysis shows that SIRI has more remarkable relationship with the mortality of PQ poisoning in patients whose age were 14-17 years or the duration of illness ranged from 6 hours to 11 hours(AUC_(<18years)=86.25%,AUC_(6-11)h=84.13%).Conclusion SIRI can be used as a predictor related to in-hospital death in acute PQ poisoning patients.Among groups aged 14 to 17 or patients whose duration between onset of poisoning are ranged from 6 hours to 11 hours,SIRI has a significant value to assess and forecast their risk of in-hospital mortality.

关 键 词：百草枯 中毒 炎症指标 预后 

分 类 号：R595.4[医药卫生—内科学]