河北医科大学学报 ›› 2023, Vol. 44 ›› Issue (1): 42-45,50.doi: 10.3969/j.issn.1007-3205.2023.01.009

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急性百草枯中毒患者30 d预后影响因素的研究

  

  1. 1.西安交通大学第一附属医院急诊科，陕西 西安 710061；2.西安交通大学第二附属医院急诊科，陕西 西安 710004

  • 出版日期:2023-01-25 发布日期:2023-01-17
  • 作者简介:樊丹丹(1983-)，女，湖北宜城人，西安交通大学第一附属医院主治医师，医学硕士，从事急性中毒诊治研究。
  • 基金资助:
    国家自然科学基金资助项目（81601674）

Study on influencing factors of 30-day prognosis in patients with acute paraquat poisoning

  1. 1.Department of Emergency, the First Affiliated Hospital of Xi′an Jiaotong University, Shaanxi Province, 
    Xi′an 710061, China; 2.Department of Emergency, the Second Affiliated Hospital of 
    Xi′an Jiaotong University, Shaanxi Province, Xi′an 710004, China

  • Online:2023-01-25 Published:2023-01-17

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摘要： 目的  探讨应用血液净化治疗后，急性百草枯中毒患者30 d预后的影响因素。
方法  选取西安交通大学第一及第二附属医院符合纳排标准急性百草枯中毒患者(79例)，电话随访服毒30 d时的预后，分为死亡组(n=40)及存活组(n=39);比较两组年龄、性别、既往高血压史、糖尿病史、服毒量、服毒至就诊的时间、中性粒细胞计数/淋巴细胞计数比值、单核细胞计数/淋巴细胞计数比值、尿素氮、肌酐、天冬氨酸转氨酶、丙氨酸转氨酶、凝血酶原时间、凝血酶时间及急性病生理学和长期健康评价(acute physiology and chronic health evaluation Ⅱ,APACHEⅡ)，采用二分类Logistic回归分析预测死亡组的危险因素；采用受试者工作特征曲线下面积(area under curve,AUC)分析服毒量对死亡组的预测价值；应用Kaplan-Meier生存曲线分析服毒量与30 d预后的关系。
结果  服毒量及APACHEⅡ为30 d死亡的独立危险因素(P＜0.05)；服毒量预测死亡组的AUC为0.882(P＜0.001)，临界值为40 mL(敏感度72.5%，特异度87.18%)；APACHEⅡ预测死亡组的AUC为0.722(P＜0.001)，临界值为4(敏感度85%，特异度87.18%)；Kaplan-Meier生存曲线：服毒量＞40 mL组与服毒量≤40 mL组在30 d累积生存率上差异有统计学意义(χ2=48.452，Log-rank P＜0.001)。
结论  服毒量和APACHEⅡ可预测急性百草枯中毒患者的30 d预后，服毒量≤40 mL和APACHEⅡ≤4提示近期预后较好。


关键词: 百草枯, 预后, 血液净化

Abstract: Objective  To explore the influencing factors of 30-day prognosis in patients with acute paraquat poisoning(APP) after blood purification. 
Methods  A total of 79 patients with APP who met the inclusion and exclusion criteria in the First Affiliated Hospital of Xi′an Jiaotong Universityand the Second Affiliated Hospital of Xi′an Jiaotong University were selected. The 30-day prognosis was obtained by telephone interview. They were divided into the death group(n=40) and the survival group(n=39). Age, gender, history of hypertension, history of diabetes, poisoning dose, time from taking poison to seeing a doctor, the ratio of neutrophil to lymphocyte, the ratio of monocyte to lymphocyte, blood urea nitrogen, creatinine, aspartate aminotransferase, alanine aminotransferase, prothrombin time, thrombin time, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) were compared between two groups. Binary logistic regression analysis was used to predict the risk factors of death. The area under the receiver operating characteristic(ROC)curve(AUC) was used to analyze the predictive value of the poisoning dose of the death group. Kaplan-Meier survival curve was used to analyze the relationship between poisoning dose and 30-day prognosis. 
Results  The poisoning dose and APACHE Ⅱwere independent risk factors for 30-day prognosis(P＜0.05). The AUC of poisoning dose in the death group for predicting 30-day mortality was 0.882(P＜0.001), and the cutoff value was 40 mL(sensitivity of 72.5%, specificity of 87.18%). The AUC of APACHE Ⅱ in the death group for predicting 30-day mortality was 0.722(P＜0.001), and the cutoff value was 4(sensitivity of 85%, specificity of 87.18%). Kaplan-Meier survival curve showed that there was significant difference between poisoning dose＞ 40 mL group and poisoning dose≤40 mL group with respect to 30-day cumulative survival rate(χ2=48.452，Log-rank P＜0.001). 
Conclusion  The poisoning dose and APACHE Ⅱ can predict the 30-day prognosis of patients with APP. The poisoning dose ≤ 40 mL and APACHE Ⅱ ≤ 4 indicate favorable short-term prognosis. 


Key words: paraquat, prognosis, blood purification

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