急性有机磷农药中毒患者肝功能及酶谱变化的研究

Changes of Serum Hepatic Function and Enzymogram in Patients with Acute Organophosphorus Pesticide Poisoning

目的探讨有机磷农药中毒患者肝功能及酶谱的变化。方法对68例急性有机磷农药中毒患者于中毒后20h内抽取静脉血进行肝功能、酶谱及胆碱脂酶(ChE)检测,并与61例治愈组和65例对照组进行比较。结果患者乳酸脱氢酶(LDH)有明显升高而ChE有明显降低(P<0.001);中度中毒总胆红素(TBIL)、直接胆红素(DBIL)、天门冬氨酸转移酶(AST)、LDH明显升高而总蛋白(TP)、白蛋白(ALB)、碱性磷酸酶(ALP)、γ-谷氨酰基转移酶(GGT)、ChE明显降低(P<0.001);重度中毒丙氨酸氨基转移酶(ALT)、TBIL、DBIL、AST、LDH升高明显而TP、ALB、ALP、GGT、ChE降低明显(P均<0.001),ALT升高明显,而ALP、GGT非但不降低反而升高接近正常水平者,预后不佳。结论观察血清肝功能及酶谱的变化可以判断有机磷农药中毒患者的中毒程度、预后及疗效。

Objective To explore the changes of hepatic function and enzymogram in patients with organophosphorus pesticide poisoning. Methods Blood simples were taken for the measurement of serum hepatic function, enzymogram and ChE in 68 cases with acute organophosphorus pesticide poisoning within 24 hours after intoxication. The result was compared to the recovered group （n = 6i ） and the control group （65 health subjects）. ResuIts In poisoning cases, the lactate dehydrogenase （LDH） raised and ChE decreased obviously （ all P 〈 0. 001 ） ; in moderate poisoning cases, total bilirubin （ TBIL）, direct bilirubin （DBIL）, aspartate aminotransferase （AST）, and LDH levels were increased obviously, but total protein （TP）, Albumin （ALB）, alkaline phosphatase （ALP）, γ-glutamyl transferase （GGT） and ChE levels were decreased obviously （all P 〈 0. 001 ） ; in severe poisoning cases, alanine transaminase （ALT）, AST, TBIL, DBIL and LDH levels were raised obviously, TP, ALB, ALP, GGT, ChE were decreased obviously（ all P 〈 0. 001 ）. The cases with high ALT, ALP and GGT levels had unfavorable prognosis. Conclusions To observe the hepatic function and hepatic enzymogram changes was helpful to judge the degree of poisoning, prognosis of patients and treatment efficiency in patients with acute organophosphorus pesticide poisoning.