重度急性有机磷农药中毒患者N末端脑钠肽前体和血磷的变化和意义

Change and significance of concentration of blood phosphorus and N-terminal pro-brain natriuretic peptide in patients with severe acute organophosphorus pesticide poisoning

目的探讨重度急性有机磷农药中毒（AOPP）患者N末端脑钠肽前体（NT-pmBNP）和血磷变化的临床意义。方法选取78例重度AOPP患者，分为死亡组（54例）和存活组（24例）。分别于入院时，入院1、2,4d后，转出ICU时或死亡前检测NT。pmBNP和血磷。结果两组入院时NT-proBNP和血磷比较差异无统计学意义（P〉0．05）；入院1、2、4d后，死亡组NT-proBNP明显高于存活组[死亡组：（1986．5±24．9）、（3568．2±56．9）、（7829．0±64．3）ng／L；存活组：（1068．4±20．2）、（986．6±16.4）、（943．7±14．6）ng，L，P〈0．05或〈0．01]，血磷明显低于存活组[死亡组：（1．22±0．13）、（0．81±0．10）、（0．58±0．07）mmol／L；存活组：（1．53±0．16）、（1．48±0．13）、（1．46±0．14）mmol／L，P〈0．05或〈0．01]；且随着时间的延长，死亡组患者的NT-proBNP逐渐升高（P〈0．05），血磷逐渐降低（P〈0．05）；存活组在转出ICU时NT-pmBNP较人院时明显降低[（327．5±12．3）ng／L比（1023．3±18．8）ng，L，P〈0．05]；存活组各时间点血磷比较差异无统计学意义（P〉O．05）；死亡组死亡前NT．pmBNP明显高于存活组转出ICU时[（31486．5±120．7）ng，L比（327．5±12．3）ng／L，P〈0．01]，血磷明显低于存活组转出ICU时[（0．24±0．03）mmol／L比（1．57±0．15）mmol／L，P〈0．01].结论重度AOPP患者随着病情的进展，N^pmBNP逐渐升高，血磷逐渐降低，N％pmBNP和血磷是反映重度AOPP患者预后指标。

Objective To observe the change of blood phosphorus and N-terminal pro-brain natriuretic peptide（NT-proBNP） in patients with severe acute organophosphorus pesticide poisoning （AOPP） and explore their clinical significance. Methods Seventy-eight severe AOPP patients were selected and divided into dead group （54 cases） and survival group （24 cases）. NT-proBNP and blood phosphorus were examined when the patients were just hospitalized, and after 1, 2, 4 d and when they were turn out from ICU or before the patients dead. Results Comparing with survival group, blood phosphorus and NT-proBNP of dead group had no significant difference when the patients were just hospitalized（P〉 0.05）. After 1, 2 and 4 d NT-proBNP of dead group [（1986.5 ±24.9）, （3568.2 ± 56.9）, （7829.0 ±64.3） ng/L] was higher than that of survival group [ （ 1068.4 ± 20.2）, （986.6 ± 16.4）, （943.7 ±14.6） ng/L, P 〈 0.05 or 〈 0.01 ], while blood phosphorus was significant lower than that in survival group [ （ 1.22 ＋ 0.13 ）, （0.81 ±0.10）, （0.58 s- 0.07 ） mmol/L vs. （ 1.53 ± 0.16）, （ 1.48 ± 0.13 ）, （ 1.46 ± 0.14） mmol/L, P 〈 0.05 or 〈 0.01 ]. NT-proBNP of dead group increased and blood phosphorus reduced gradually by time extending （P 〈 0.05）. NT-proBNP was lower when patients were turn out from ICU than that when the patients were just hospitalized [ （327.5 ± 12.3 ） ng/L vs. （1023.3± 18.8） ng/L, P 〈 0.05 ]. Blood phosphorus had no difference at all time points in survival group （P〉 0.05）. NT-proBNP was higher [（31 486.5 ± 120.7） ng/L vs.（327.5 ± 12.3） ng/L,P〈 0.01 ] and blood phosphorus was lower [ （0.24 ± 0.03 ） mmol/L vs. （ 1.57 ±0.15 ） mmol/L,P 〈 0.01 ] before death in dead group compared with those at the time turning out from ICU in survival group. Conclusions The value of NT-proBNP increased and blood phosphorus reduced gradually with disease prograssion. NT-proBNP and blood phosphorus were important factors reflecting the prognosis of blood AOPP patients.