急性有机磷中毒合并肝损伤患者AST、ChE、CRP动态变化及对病情的评估价值

Dynamic changes and evaluation value of AST,ChE,CRP on acute organophosphorus pesticide poisoning patients combined with liver injury

目的动态监测急性有机磷中毒(acute organophosphorus pesticide poisoning,AOPP)合并肝损伤患者天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、胆碱酯酶(cholinesterase,ChE)和C反应蛋白(C-reactive protein,CRP)变化并评估其对病情转归的预测效能。方法选取2017年1月至2021年12月高邮市人民医院收治的60例AOPP合并肝损伤患者,根据病情转归情况分为生存组(31例)和病死组(29例),比较两组基线资料以及入院时、第3天和第7天AST、ChE、CRP变化,采用Cox回归分析AOPP预后的影响因素,采用受试者工作特征(receiver operator characteristic,ROC)曲线分析第3天AST、ChE、CRP对预后的预测价值。结果病死组有机磷暴露量多于生存组[(97.26±12.07)ml比(58.97±8.43)ml],APACHEⅡ评分[(31.23±6.86)分比(25.18±5.72)分]高于生存组;病死组入院第3天和入院第7天AST[3 d:(167.99±18.36)U/L比(91.35±16.58)U/L;7 d:(55.62±13.59)U/L比(28.71±6.44)U/L]、CRP高于生存组[3 d:(76.39±22.03)mg/L比(54.55±17.60)mg/L;7 d:(73.66±24.87)mg/L比(32.90±8.46)mg/L],ChE低于生存组[3 d:(44.59±7.08)%比(48.91±6.33)%;7 d:(43.12±8.53)%比(57.49±12.27)%],差异均有统计学意义(P均<0.05)。Cox回归分析表明有机磷暴露量(HR=15.791,95%CI:4.685~53.225,P<0.001)、APACHEⅡ评分(HR=12.166,95%CI:2.208~67.039,P<0.001)、入院第3天AST(HR=6.670,95%CI:1.162~38.283,P<0.001)、CRP(HR=8.208,95%CI:1.573~42.829,P<0.001)为AOPP患者预后不良的危险因素,入院第3天ChE为保护性因素(HR=0.362,95%CI:0.159~0.825,P<0.001)。入院第3天AST、ChE、CRP联合预测预后的ROC曲线下面积为0.900,均显著高于AST(0.852;Z=2.754,P=0.045)、ChE(0.804;Z=3.184,P=0.032)、CRP(0.818;Z=3.075,P=0.026)单独的ROC曲线下面积。结论AOPP合并肝损伤不同预后患者入院后AST、ChE、CRP呈现不同变化特点,动态监测三者变化有助于早期预测患者病情转归,为临床管理提供参考。

Objective To dynamically monitor the changes of aspartate aminotransferase(AST),cholinesterase(ChE)and C-reactive protein(CRP)in patients with acute organophosphorus poisoning(AOPP)combined with liver injury and to investigate the predictive efficacy of prognosis.Methods Total of 60 AOPP patients with liver injury in Gaoyou City People’s Hospital from January 2017 to December 2021 were selected and divided into survival group(31 cases)and death group(29 cases)according to their prognosis.The baseline data,changes in AST,ChE,and CRP at admission,3 days and 7 days of patients in two groups were compared.Cox regression analysis was used to analyze the influencing factors of AOPP prognosis.Receiver operator characteristic(ROC)curve was used to analyze the predictive value of AST,ChE and CRP at 3 days on the prognosis of AOPP.Results Organophosphorus exposure[(97.26±12.07)ml vs.(58.97±8.43)ml]and APACHEⅡscore[(31.23±6.86)points vs.(25.18±5.72)points]of patients in death group were significantly higher than those of survival group(all P<0.05).The levels of AST[3 d:(167.99±18.36)U/L vs.(91.35±16.58)U/L;7 d:(55.62±13.59)U/L vs.(28.71±6.44)U/L]and CRP[3 d:(76.39±22.03)mg/L vs.(54.55±17.60)mg/L;7 d:(73.66±24.87)mg/L vs.(32.90±8.46)mg/L]of patients in death group at 3 days and 7 days after admission were significantly higher than those of survival group,while the levels of ChE[3 d:(44.59±7.08)%vs.(48.91±6.33)%;7 d:(43.12±8.53)%vs.(57.49±12.27)%]were significantly lower(all P<0.05).Cox regression analysis showed that organophosphorus exposure(HR=15.791,95%CI:4.685~53.225,P<0.001),APACHEⅡscore(HR=12.166,95%CI:2.208~67.039,P<0.001),AST(HR=6.670,95%CI:1.162~38.283,P<0.001)and CRP(HR=8.208,95%CI:1.573~42.829,P<0.001)levels at 3 days after admission were risk factors for a poor prognosis in patients with AOPP,and ChE level at 3 days after admission was a protective factor(HR=0.362,95%CI:0.159~0.825,P<0.001).The area under the ROC curve of combined AST,ChE and CRP at 3 days after admission was 0.900,which was significantly higher than AST(0.852;Z=2.754,P=0.045),ChE(0.804;Z=3.184,P=0.032)and CRP(0.818;Z=3.075,P=0.026)alone.Conclusions The dynamic monitoring of the changes of AST,ChE and CRP can help to predict disease regression at an early stage,thus providing important reference information for clinical management.