急性百草枯中毒患者预后评价指标的比较

Comparison of Prognostic Indicators of Acute Paraquat Poisoning

目的探讨急性百草枯(PQ)中毒患者口服PQ量(I-PQ)、入院时血清PQ水平(C-PQ)以及PQ中毒严重指数(SIPP)对预后的评估价值。方法选取2012年1月—2014年3月连云港市第一人民医院收治的急性PQ中毒24 h内入院患者65例为研究对象,收集患者性别、年龄、是否行血液灌流(HP)治疗、服毒至入院时间(T-lag)、I-PQ、入院时C-PQ及SIPP,按30 d内是否死亡分为存活组(23例)和死亡组(42例)。结果死亡组I-PQ、入院时C-PQ和SIPP均高于存活组(P<0.05)。死亡组患者存活时间中位数为7(10)d,I-PQ、入院时CPQ、SIPP与患者存活时间均呈负相关(rs=-0.518、-0.824、-0.767,P<0.01)。I-PQ临界值为35.0 ml时,其评估急性PQ中毒患者30 d死亡的灵敏度为86%,特异度为78%,ROC曲线下面积为〔0.895,95%CI(0.812,0.978),P<0.001〕。入院时C-PQ临界值为6.3 mg/L时,其评估急性PQ中毒患者30 d死亡的灵敏度为98%,特异度为100%,ROC曲线下面积为〔0.998,95%CI(0.992,1.000),P<0.001〕。SIPP临界值为22.0 h·mg·L-1时,其评估急性PQ中毒患者30 d死亡的灵敏度为95%,特异度为87%,ROC曲线下面积为〔0.974,95%CI(0.942,1.000),P<0.001〕。结论入院时C-PQ与SIPP对急性PQ中毒患者预后的评估价值优于I-PQ,但在无法检测CPQ时,I-PQ仍不失为一个评估预后较可靠的指标。

Objective To examine the value of the amount of paraquat ingestion（ I - PQ ）, plasma paraquat concentration（ C - PQ）at admission,and severity index of paraquat poisoning（ SIPP）in the prognosis of acute paraquat poisoning. Methods The clinical data of 65 patients with acute paraquat poisoning admitted into the First People′s Hospital of Lianyungang within 24 hours after poisoning between January 2012 and March 2014 were retrospectively collected. Gender,age, receiving HP treatment or not,time elapsed from poisoning to admission（ T-lag）,I-PQ,C-PQ at admission and SIPP were examined. Based on whether death occurred within 30 days after poisoning,the subjects were divided into survival group（ n=23）and death group（n=42）. Results Death group was significantly higher（P〈0. 05）in I-PQ,C-PQ at admission and SIPP than in survival group. The median survival time for patients in the death group was 7 （ 10 ）days. There were negative correlations（rs = -0. 518,-0. 824,-0. 767,P〈0. 01）between I-PQ,C-PQ at admission,SIPP and survival time. For I-PQ,the critical value was 35. 0 ml,its sensitivity degree and specificity degree for predicating 30 d death were 86% and 78%,and the area under its ROC curve was〔0. 895,95%CI（0. 812,0. 978）,P〈0. 001〕. For C-PQ at admission,the critical value was 6. 3 mg/L,its sensitivity degree and specificity degree for predicating 30 d death were 98% and 100%,and the area under its ROC curve was〔0. 998,95%CI（0. 992,1. 000）,P〈0. 001〕. For SIPP,the critical value was 22. 0 h ·mg·L^-1 ,its sensitivity degree and specificity degree for predicating 30 d death were 95% and 87%,and the area under its ROC curve was〔0. 974,95%CI（0. 942,1. 000）,P 〈0. 001〕. Conclusion C - PQ at admission and SIPP are more effective than I-PQ in the prognosis of acute paraquat poisoning. When the measurement of C-PQ can not be conducted,I-PQ can be used as a relatively reliable indicator.