强离子隙和肝肾功能在百草枯中毒中的应用比较

Strong ion gap compared with liver and kidney function in the application of paraquat poisoning

目的 比较急性百草枯中毒患者的强离子隙（strong ion gap,SIG）水平和肝肾功能指标与其预后的相关性.方法 回顾性研究2006年到2013年共148例口服百草枯中毒的患者,根据预后被分为生存组和死亡组,比较中毒早期强离子隙、谷丙转氨酶（glutamic pyruvictransaminase,ALT）、谷草转氨酶（glutamic oxalacetic transaminase,AST）、肌酐（creatinine,Cr）、尿素氮（blood urea nitrogen,BUN）指标的水平以及其他一般资料结果,并通过分析优势比（oddsratio,OR）以及建立ROC曲线比较强离子隙水平和肝肾功能指标对百草枯中毒患者的预后有效性.结果 异常的谷丙转氨酶（x2=10.257,P=0.001）、谷草转氨酶（x2=9.109,P=0.003）、肌酐（x2=10.257,P=0.021）、尿素氮（x2 =10.257,P＜0.001）较正常的指标对患者预后有更高的死亡风险,SIG较ALT、AST、Cr、BUN对致死率有明显的ORs （P ＜0.05）.在ROC曲线中,SIG、ALT、AST、Cr、BUN对死亡预后的曲线下面积分别为0.822、0.708、0.724、0.603、0.625.结论 随着百草枯中毒患者早期的SIG、ALT、AST、Cr、BUN水平的升高,百草枯中毒患者的死亡风险增加,且SIG对患者的死亡预后较肝肾功能指标更有效.

Objective To compare the strong ion gap （SIG） and liver and kidney function index predicting the prognosis of acute paraquat poisoning patients.Methods Retrospective study with a total of 148 cases from 2006 to 2013 who were diagnosed by paraquat poisoning,according to the prognosis they are divided into survival group and death group.Compared with the early SIG,ALT,AST,Cr,BUN index level to analyze with the odds ratio （ORs） and established ROC curve to conform which is more effective on the prognosis of patients with paraquat poisoning.Results The abnormal index of glutamic pyruvic transaminase （ALT） （x2=10.257,P =0.001）,glutamic oxalacetic transaminase （AST） （x2=9.109,P =0.003）,creatinine （Cr） （x2=10.257,P =0.021）,blood urea nitrogen （BUN） （x2=10.257,P 〈 0.01） indicated a higher risk of death than the normal index,SIG showed higher ORs for fatality than ALT,AST,Cr,BUN （P 〈 0.05）.In the ROC curve,the area under the curve of the SIG,ALT,AST,Cr,BUN on the prognosis of fatality were 0.822,0.708,0.724,0.603,0.625.Conclusions With early SIG and ALT,AST,Cr,BUN level increased,the risk of death will increase in paraquat poisoning patients,and SIG is a more effective marker than index of kidney and liver function on the prognosis of death.