敌草快混合百草枯中毒患者急性肾损伤的临床特点及危险因素分析  

Clinical characteristics and risk factors analysis of acute kidney injury in patients with diquat mixed with paraquat poisoning

作　　者：桂久玖 李柯 叶健萍 丁溢姣 唐虎 唐亚慧[1] 吴斌[1] 卢中秋[1] Gui Jiujiu;Li Ke;Ye Jianping;Ding Yijiao;Tang Hu;Tang Yahui;Wu Bin;Lu Zhongqiu(Emergency Department,The First Affiliated Hospital of Wenzhou Medical University,Institute of Emergency Medicine,Wenzhou Medical University,Wenzhou Key Laboratory of Emergency Critical Disease and Rescue Medicine,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第一医院急诊医学中心,温州医科大学急诊医学研究所,温州市急危重病与救援医学重点实验室,温州325000

出　　处：《中华急诊医学杂志》2025年第3期350-358,共9页Chinese Journal of Emergency Medicine

基　　金：国家自然科学基金项目(82302482);国家中医药管理局-浙江省中医药管理局共建科技计划项目(GZY-ZJ-KJ-23031);温州市科技局重大科技创新攻关项目(ZY2022023);浙江省临床重点专科急诊医学科。

摘　　要：目的 探讨敌草快(diquat,DQ)混合百草枯(paraquat,PQ)中毒患者急性肾损伤(acutekidney injury,AKI)的临床特点并分析其危险因素。方法 回顾性分析2016年1月20日至2024年6月10日本院急诊科收治的210例PQ、DQ以及混合中毒患者的临床资料。根据毒物检测结果,将患者分为PQ组、DQ组和混合中毒组,对比三组的临床指标、AKI发生率及严重程度。将混合中毒患者按院内是否发生AKI分为AKI组和非AKI组,比较两组各项指标的差异。采用单因素Logistic分析及最小绝对收敛和选择算子(least absolute shrinkage and selection operator,Lasso)回归法筛选危险因素,多因素Logistic回归建立模型,绘制受试者操作特征(receiver operating characteristic curve,ROC)曲线,分析混合中毒患者发生AKI的影响因素,并评估其预测价值。结果 共纳入PQ组88例,DQ组28例,混合中毒组57例。三组在年龄、死亡人数、服毒量、身体质量指数(body mass index,BMI)、AKI发生率、脏器支持治疗率、人院全身炎症反应综合征评分(systemic inflammatory response syndrome score,SIRS评分)、人院急性生理及慢性健康评分(APACHEⅡI评分)、人院中毒严重度评分(PSS评分)等方面差异有统计学意义(P<0.05)。三组均发生不同程度的AKI,其中混合中毒患者AKI发生率更高且病情更重。混合中毒患者中AKI组与非AKI组相比,AKI组在年龄、病死率、服毒量、人院SIRS评分、APACHE IⅡI评分、PSS评分、入院血浆PQ浓度、入院血浆DQ浓度、白细胞计数、中性粒细胞计数、单核细胞计数、血肌酐、降钙素原、C反应蛋白、丙氨酸转氨酶、天冬氨酸转氨酶、血乳酸和胱抑素C方面均显著升高(P<0.05),而肾小球滤过率估算值(estimatedglomeruralfiltrationrate,eGFR)和二氧化碳分压显著降低(P<0.05)。混合中毒患者中,AKI组服毒后不同时间点的血肌酐值均高于非AKI组(P<0.05),且呈上升趋势,服毒后第五天达到峰值(212.19±101Objective To explore the clinical characteristics and risk factors of acute kidney injury(AKI)in patients with diquat mixed with paraquat poisoning.Methods We retrospectively analyzed the clinical data of 210 patients admitted to the department of emergency at our hospital with paraquat,diquat or mixed poisoning from January 20,2016,to June 10,2024.Based on the detection results of plasma toxicants,patients were categorized into three groups:the paraquat group(PQ group),and the diquat group(DQ group),the diquat-paraquat mixed group(mixed group).We compared clinical indices,occurrence,and severity of AKI among these groups.In the mixed group,patients were further divided into AKI and non-AKI subgroups based on the presence of AKI during hospitalization,and differences in clinical indices between these subgroups were analyzed.Univariate logistic regression and least absolute shrinkage and selection operator(Lasso)regressions were used to screen risk factors,and multivariate logistic regression was applied to establish the model.ROC curves were generated,and factors influencing AKI occurrence in the mixed group were identified.Results A total of 88 patients were included in the PQ group,28 in the DQ group,and 57 in the mixed group.Significant differences were observed among the three groups in terms of age,mortality rate,ingestion amount,body mass index(BMI),occurrence of AKI,the incidence of organ support therapy,SIRS score,PSS score,and APACHE II score on admission(P<0.05).All three groups exhibited various degrees of AKI,with the mixed group showing a higher proportion and more severe conditions.In the mixed group,compared with the non-AKI group,the AKI group showed significantly higher values for age,number of deaths,ingestion amount,SIRS score,PSS score,APACHE II score,plasma PQ concentration on admission,plasma DQ concentration on admission,white blood cell count(WBC),neutrophil count(NEUT),monocyte count(MONO),serum creatinine(SCr),procalcitonin(PCT),c-reactive protein(CRP),alanine aminotransferase(ALT),aspar

关 键 词：敌草快 百草枯 混合中毒 急性肾损伤 临床特点 危险因素 

分 类 号：R69[医药卫生—泌尿科学]