丁酰胆碱酯酶活性在评估院前急性乐果中毒患者病情及预后的应用研究

Clinical application of butyrylcholinesterase activity assessing conditions and prognosis of pre-hospital acute dimethoate poisoning

目的丁酰胆碱酯酶活性（BuChE）在院前急性乐果中毒患者病情评估和死亡预测的价值及可行性。方法对2010年1月1日~2011年12月31日院前急性乐果中毒患者作为研究对象,采集血丁酰胆碱酯酶活性,以收入院后60 d为观察终点,结局作为观察指标,对患者进行丁酰胆碱酯酶活性特征曲线（ROC曲线）下面积计算,计算患者相应的预测指标。结果共有115例乐果中毒患者纳入研究,其中丁酰胆碱酯酶活性≤30%正常值的患者23例次,占20.0%,丁酰胆碱酯酶活性〉30%正常值的患者92例次,占80.0%;死亡组丁酰胆碱酯酶活性较存活组低,差异有统计学意义（P〈0.05）;丁酰胆碱酯酶活性ROC曲线下面积为0.962,判断院前中毒患者＂潜在危重症＂的最佳截断点为≤正常值30%,对危重症患者死亡预测的敏感度76.0%,特异度为95.5%,准确度为91.3%,约登指数为0.715。结论丁酰胆碱酯酶活性在急性乐果中毒患者病情评估及死亡的预测具有较强的应用价值。

【Objectives】 To study the significance and feasibility of butyrylcholinesterase（BuChE） activity assessing the conditions and death prediction among the pre-hospital acute poisoning dimethoate patients.【Methods】 Data of the pre-hospital acute dimethoate poisoning patients between January 1,2010 and December 31,2011 were collected and Plasma BuChE activity were measured on admission.Observation terminal was 60 days after admission taking the results as observation index and ROC was drew and the area under the curve and the predicting index were calculated.【Results】 It showed 23 person times with BuChE activity ≤30% of normal activity,accounting 20.0%,92 person times with BuChE activity 30% of normal activity,accounting for 80.0%,among the dead patients,BuChE activity were less than those of the survival group with statistic significance（P 0.05）.The area under ROC was 0.962 indicating that BuChE activity ≤30% of normal activity was the board line for severe pre-hospital acute dimethoate poisoning patients with sensitivity of 76.0%,specificity of 95.5%,accuracy of 91.3% and Youden of 0.715 predicting death.It showed high significance of the application of BuChE activity in assessing acute dimethoate poisoning patients and death prediction.【Conclusion】 BuChE activity assesses pre-hospital acute dimethoate poisoning patients and predict death with good resolution and strong application significance,which is simple,practical and applicable.