内皮素与急性百草枯农药中毒后多器官功能障碍综合征的相关性研究

Correlation of plasma endothelin and multiple organ dysfunction syndrome caused by acute paraquat poisoning

目的探讨内皮素(ET)与急性百草枯中毒(APP)后多器官功能障碍综合征(MODS)的关系及临床价值。方法应用放射免疫技术测定24例APP伴MODS患者与19名健康人血浆ET水平,分析APP后MODS患者血浆ET水平和急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分、动脉血氧分压(PaO2)、心肌肌钙蛋白I(cTnI)、血清酶学、血生化等指标的关系。结果APP伴MODS患者血浆ET水平较正常对照组明显升高(P<0.01),而死亡组血浆ET水平明显高于存活组(P<0.01)。血浆ET含量与APACHEⅡ评分、cTnI、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、血尿素氮(BUN)、血肌酐(SCr)呈正相关(P<0.05或P<0.01),与PaO2呈显著负相关(P<0.01)。结论ET参与了APP后MODS的发病过程,且与APACHEⅡ评分呈正相关;血浆ET含量水平可作为APP后MODS患者多器官功能损害程度的评估、指导治疗与预后判断的临床指标之一。

Objective To investigate the relationship between endothelin (ET) and multiple organ dysfunction syndrome (MODS) caused by acute paraquat poisoning (APP). Methods The levels of plasma ET were measured by radioimmunoassay in 24 patients with MODS caused by APP and 19 healthy persons as controls. The levels of plasma ET patients in MODS caused by APP were correlatively analysed with acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, partial pressure of oxygen in artery(PaO2), troponin I(cTnI) level, blood enzymology and biochemistry indexes. Results The levels of plasma ET in patients with MODS caused by APP were much higher than controls (P<0. 01), the level of plasma ET in death group was much higher than that of survivor group (P<0. 01). Plasma ET was positively correlated with APACHE Ⅱ score, cTnI, MB isoenzyme of creatine kinase (CK-MB), lactate dehydrogenase (LDH), alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN) and serum creatinine (SCr, P<0. 05 or P<0. 01), where there was a negative correlation with PaO2 (P<0. 01). Conclusion Endothelin may be involved in the pathogenesis of MODS caused by APP, plasma ET may be one of a clinical index for evaluating the degree of multiple organ function damage, for guiding treatment, and judging the prognosis of MODS caused by APP.