急性有机磷农药中毒心肌损伤最佳标志物的研究

Study on the best marker for myocardial damage of acute organophosphorus pesticide poisoning

目的 探讨急性有机磷农药中毒（AOPP）6 h后心肌损伤最佳标志物。方法 选取2006年5月-2014年11月就诊于首都医科大学电力教学医院（以下简称“我院”）急诊科的86例AOPP患者作为观察组,按《职业性急性有机磷杀虫剂中毒诊断标准》（GBZ8-2002）分成轻度、中度和重度中毒3组。所有患者常规行12导联心电图检查,均于服毒后6 h检测肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、心肌肌钙蛋白I（c Tn I）。对照组来源于我院门诊健康体检者,体检当天检测CK、CK-MB、c Tn I。观察各组上述3项指标。结果 观察组与对照组CK、CK-MB、c Tn I水平比较差异有统计学意义（P〈0.05）。轻度中毒组与对照组CK、CK-MB水平比较差异无统计学意义（P〉0.05）,c Tn I水平差异有统计学意义（P〈0.05）;中度及重度中毒组与对照组CK、CK-MB、c Tn I水平比较差异有统计学意义（P〈0.05）。中度及重度中毒组与轻度中毒组CK、CK-MB水平比较差异有统计学意义（P〈0.05）,c Tn I水平差异有高度统计学意义（P〈0.01）。重度中毒组与中度中毒组CK水平比较差异无统计学意义（P〉0.05）,CK-MB水平差异有统计学意义（P〈0.05）,c Tn I水平差异有高度统计学意义（P〈0.01）。结论 c Tn I是判断AOPP心肌损伤的最敏感指标,是AOPP心肌损伤的最佳标志物,CK-MB次之。CK和心电图对判断AOPP心肌损伤及损伤程度价值不大。

Objective To explore the best marker for myocardial injury after 6 hours of acute organophosphorus pesticide poisoning（AOPP）. Methods 86 cases of AOPP patients in Department of Emergency,Electric Power Teaching Hospital of Capital Medical University（ ＂our hospital＂ for short） from May 2006 to November 2014 were selected as observation group. They were divided into mild poisoning group,moderate poisoning group and severe poisoning group according to the Occupational Acute Organophosphorus Pesticide Poisoning（GBZ8-2002）. All patients were routinely done for 12 lead ECG examination and examined for CK,CK-MB,c Tn I in 6 hours after taking poison. Control group was from our hospital outpatient health examination,and CK,CK-MB,c Tn I levels were examined the same day. The above three indicators of each group were observed. Results There were statistical differences in CK,CK-MB,c Tn I levels between observation group and control group（P〈 0.05）. There were no statistical differences in CK,CK-MB levels between mild poisoning group and control group（P 〉0.05）,and there was statistical difference in c Tn I level between mild poisoning group and control group（P 〈0.05）. There were statistical differences in CK,CK-MB,c Tn I levels between moderate poisoning group and control group,severe poisoning group and control group（P 〈0.05）. There were statistical differences in CK,CK-MB levels between moderate poisoning group and mild poisoning group,severe poisoning group and mild poisoning group（P 〈0.05）. There was significantly statistical difference in c Tn I level between moderate poisoning group and mild poisoning group,severe poisoning group and mild poisoning group（P 〈0.01）. There was no statistical difference in CK level between severe poisoning group and moderate poisoning group（P 〉0.05）.There was statistical difference in CK-MB level between severe poisoning group and moderate poisoning group（P 〈0.05）. There was significantly statistical difference in c Tn I level between severe poisoning group and moderate poisoning group（P 〈0.01）. Conclusion c Tn I is the most sensitive index of AOPP,and is the best marker for AOPP myocardial damage,CK-MB times. The value of CK and ECG in the injury of AOPP is not.