外周血CD39/ATP轴和PON1及miR-214在急性有机磷中毒病情评估及预后预测中的临床意义

The clinical significance of peripheral blood CD39/ATP axis,PON1 and miR-214 in the evaluation the severity of acute organophosphate poisoning and the prediction of prognosis

目的探究外周血CD39/三磷酸腺苷(ATP)轴、对氧磷酶1(PON1)、miR-214在急性有机磷中毒(AOPP)患者中的临床价值。方法选取资阳市第一人民医院2018年6月-2020年8月收治的AOPP患者104例,根据住院期间是否死亡分为存活组(n=77)与死亡组(n=27)。比较两组入院时临床资料、外周血CD39/ATP轴、PON1、miR-214水平,评价外周血指标CD39、ATP、PON1、miR-214与中毒严重程度(PSS)评分、急性生理与慢性健康评价系统Ⅱ(APACHEⅡ)评分相关性,分析AOPP预后影响因素,评价外周血指标CD39、ATP、PON1、miR-214对预后的预测价值。结果两组中毒至就诊时间、有机磷摄入量、PSS评分、APACHEⅡ评分差异有统计学意义(χ^(2)/t=14.276、20.680、23.168、6.958,P均<0.001)。死亡组外周血CD39、miR-214高于存活组,ATP、PON1低于存活组,差异均有统计学意义(t=9.523、7.246、5.982、4.912,P均<0.001)。Pearson相关性分析显示,外周血CD39、miR-214与PSS、APACHEⅡ评分呈正相关(r=0.707、0.547;0.588、0.445),ATP、PON1与PSS、APACHEⅡ评分呈负相关(r=-0.634、-0.514;-0.505、-0.510)(P<0.05)。COX回归分析,将中毒至就诊时间、有机磷摄入量、PSS评分、APACHEⅡ评分等其他混杂因素控制后,外周血CD39、ATP、PON1、miR-214与AOPP预后显著相关(P<0.05);ROC曲线分析,将外周血CD39、ATP、PON1、miR-214进行Logistic二元回归拟合,返回预测概率Logit(P)作为独立检验变量,获取联合预测曲线下面积(AUC)为0.887,95%CI为0.812~0.963,敏感度为88.89%,特异度为79.22%,优于各指标单独预测(P<0.05)。结论外周血CD39/ATP轴、PON1、miR-214与AOPP患者病情程度显著相关,联合检测在预测预后方面具有良好价值。

Objective To explore the detection value of peripheral blood CD39/adenosine triphosphate(ATP)axis,paraoxonase 1(PON1),miR-214 in patients with acute organophosphate poisoning(AOPP).Methods A total of 104AOPP patients in Ziyang First People’s Hospital from June 2018 to August 2020 were selected.According to whether they died during hospitalization,they were divided into survival group(n=77)and death group(n=27).The clinical data,peripheral blood CD39/ATP axis,PON1 and miR-214 levels were compared between the two groups at admission.The correlation between the peripheral blood indicators(CD39,ATP,PON1,miR-214)and the poisoning severity score(PSS),the acute physiology and chronic health assessment system II(APACHE II)score was evaluated.The factors affecting the prognosis of AOPP were analyzed,and the predictive value of various peripheral blood indexes(CD39,ATP,PON1,miR-214)on the prognosis was evaluated.Results There were statistically significant differences between the two groups in the time from poisoning to treatment,the intake of organic phosphorus,PSS score,and APACHEⅡscore(χ^(2)/t=14.276,20.680,23.168,6.958,P<0.001).The peripheral blood CD39 and miR-214 in the death group were higher than those in the survival group,and ATP and PON1 were lower than those in the survival group(t=9.523,7.246,5.982,4.912,P<0.001).Pearson correlation analysis showed that peripheral blood CD39 and miR-21 were positively correlated with PSS and APACHEⅡscores(r=0.707,0.547;0.588,0.445),and ATP and PON1 were negatively correlated with PSS and APACHEⅡscores(r=-0.634,-0.514;r=-0.505,-0.510)(P<0.05).COX regression analysis showed that after controlling for other confounding factors such as the time from poisoning to treatment,organic phosphorus intake,PSS score and APACHEⅡscore,peripheral blood CD39,ATP,PON1,miR-214 were significantly correlated with the prognosis of AOPP(P<0.05).ROC curve analysis showed that the peripheral blood CD39,ATP,PON1,and miR-214 were fitted with Logistic binary regression,and the predicted probability Logit(P)was returned as an independent test variable.The area under curve(AUC)obtained for the combined prediction was 0.887,the 95%CI was 0.812 to 0.963,the sensitivity was 88.89%,and the specificity was 79.22%,which was better than the individual prediction of each index(P<0.05).Conclusion Peripheral blood CD39/ATP axis,PON1,miR-214 were significantly related to the severity of AOPP patients,and combined detection had good value in predicting prognosis.