百草枯中毒并发肺纤维化的危险因素分析

Risk factors for pulmonary fibrosis in patients with paraquat poisoning

目的探讨P0中毒并发肺纤维化的相关因素。方法选择2012年1月至2014年12月收治的120例PQ中毒患者，根据并发肺纤维化情况分为无肺纤维化组（67例）和肺纤维化组（53例）。用APACHEⅡ评分标准评估患者中毒第1天、第3天分值。记录患者入院后血常规、血生化、影像学检查等指标，随访PQ中毒患者存活和并发肺纤维化情况。结果PQ中毒患者死亡39例，病死率32．5％。发生肺间质纤维化患者53例，发生率44．2％。与无肺纤维化组比较，肺纤维化组年龄、服毒量较高，中毒第1、3天APACHE评分分值较高，差异有统计学意义（P〈0．01）。肺纤维化组中毒第1天白细胞、中性粒细胞数量，第1、3天尿素氮、肌酐、血糖水平、天冬氨酸转氨酶、丙氨酸转氨酶活力明显高于无肺纤维化组，差异有统计学意义（P〈0．01）。Logistics回归分析显示，服毒量、中毒第1天白细胞和中性粒细胞数量，中毒第1、3天APACHEⅡ评分值、尿素氮、肌酐、血糖水平、天冬氨酸转氨酶、丙氨酸转氨酶活力与PO中毒并发肺纤维化有关。结论口服PQ量，中毒第1、3天APACHEⅡ评分值、尿素氮、肌酐、血糖水平、天冬氨酸转氨酶、丙氨酸转氨酶活力，第1天白细胞和中性粒细胞数量是PQ中毒并发肺纤维化的危险因素．

Objective To investigate the risk factors for pufinonary fibrosis in patients with paraquat （PQ） poisoning. Methods A total of 120 patients with PQ poisoning who were admitted from January 2012 to December 2014 were enrolled. According to the presence or absence of pulmonary fibrosis, the patients were divided into non-pulmonary fibrosis group （67 patients） and pulmonary fibrosis group （53 patients）. The Acute Physiology and Chronic Health Evaluation II （APACHE II） score was obtained on days 1 and 3 of poisoning. Routine blood test results, blood biochemical parameters, and radiological parameters were recorded, and the patients with PQ poisoning were followed up for survival and pulmonary fibrosis. Results A total of 39 patients with PQ poisoning died, resulting in a mortality rate of 32.5%. There were 53 patients who developed pulmonary interstitial fibrosis, yielding an incidence rate of 44.2%. Compared with the non-pulmonary fibrosis group, the pulmonary fibrosis group had a significantly higher age, a significantly higher dose of PQ, and significantly higher APACHE Ⅱ scores on days 1 and 3 of poisoning（P〈0.01 ）, as well as significantly higher white blood cell （WBC） count and neutrophil count on day 1, significantly higher levels of urea nitrogen, ereatinine, and blood glucose on days 1 and 3, and significantly higher activities of aspartate aminotransferase （AST） and alanine aminotransferase （ALT） （P〈0.01）. The logistic regression analysis showed that the dose of PQ, WBC count and neutrophil count on day 1 , APACHE Ⅱ scores on days 1 and 3 of poisoning, levels of urea nitrogen, creatinine, and blood glucose, and activities of AST and ALT were associated with the development of pulmonary fibrosis in patients with PQ poisoning. Conclusion Oral dose of PQ, APACHE II scores on days 1 and 3 of poisoning, levels of urea nitrogen, creatinine, and blood glucose, activities of AST and ALT, and WBC count and neutrophil count on day 1 are risk factors for pulmonary fibrosis in patients with paraquat poisoning.