影响职业性三氯乙烯药疹样皮炎转归临床指标的研究

Study on clinical indicators impacting the prognosis of occupational medicamentosa-like dermatitis induced by trichloroethylene

目的探讨影响职业性三氯乙烯药疹样皮炎患者转归的临床指标,为指导临床病情判断及制定治疗方案提供理论参考。方法回顾性分析广东省职业病防治院1997年1月至2015年12月确诊为职业性三氯乙烯药疹样皮炎患者的完整临床资料180例。收集病例的临床资料以及患者预后转归情况。用logistic回归进行单因素和多因素分析,筛选对三氯乙烯药疹样皮炎患者转归有影响的临床指标。结果以患者的转归临床治愈或死亡作为因变量,单因素分析显示:性别、病情分型、体温、B超下检查肝脏、脾脏和腹水情况,外周血白细胞和嗜酸粒细胞计数,活化部分凝血活酶和血浆凝血酶原时间,丙氨酸氨基转移酶、天门冬氨酸氨基转移酶和胆碱酯酶的活力,总蛋白、白蛋白、球蛋白、总胆红素、直接胆红素、总胆汁酸、总胆固醇、血氨含量,入院时初始糖皮质激素的使用剂量共22个因素对患者转归有影响。多因素logistic回归分析示:病情分型、外周血白细胞计数、是否出现腹水、凝血酶原时间、总胆固醇、胆碱酯酶是影响三氯乙烯药疹样皮炎患者转归的独立因素(P<0.05);病情越重、白细胞计数越高、腹水的出现、凝血酶原时间延长、总胆固醇与胆碱酯酶数值越低,提示患者转归不良。以患者的转归短期治愈、病情迁延或死亡作为因变量,多因素logistic回归分析示,该研究所有观察指标均非影响因素(P>0.05)。结论当将转归只是分为治愈或死亡,则病情分型、外周血白细胞计数、腹水的有无、凝血酶原时间、总胆固醇、胆碱酯酶与患者的转归密切相关,可作为治疗方案制定、调整的参考依据。因研究的局限性及个体差异性,该研究的观察指标均无法在患者入院时协助预判转归是否为短期治愈、病情迁延或死亡。

Obective To investigate clinical indicators impacting the prognosis of occupational medicamentosa-like dermatitis induced by trichloroethylene and provide theoretical reference for guiding clinical judgment and formulating treatment plan.Methods Retrospective analysis of 180 cases with complete clinical data which confirmed occupational medicamentosa-like dermatitis induced by trichloroethylene and treated in Guangdong Province Hospital for Occupational Disease Prevention and Treatment from January 1997 to December 2015.The patient＇s clinical data and prognosis situation were collected.Logistic regression was performed for univariate andmultivariate regression analysis,screened the significant clinical factors which affect the prognosis of the patients.Results Single-factor analysis showed that gender,disease condition,interval between onset to admission,temperature,liver and spleen situations of B ultrasound examination,ascites situation of B ultrasound examination, peripheral white blood cell count,activated partial thromboplastin time, prothrombin time, alanine aminotransferase, aspartate aminotransferase, total protein, albumin, globulin, total bilirubin, direct bilirubin,total bile acid,cholesterol,cholinesterase,ammonia,eosinophil count,initial hormone dose total of22 factors had significant effect to the prognosis（clinical cure or death）of patients.The multiple-factor logistic analysis showed that disease condition,peripheral white blood cell count,whether there was ascites,prothrombin time,cholesterol,cholinesterase were the independent factors which affected the prognostic of patients（P〈0.05）.The more severe situation,higher value of white blood cell,emergence of ascites,prolongation of prothrombin time,lower value of cholesterol,cholinesterase,which indicate a poor prognosis.Multivariate logistic regression analysis showed that all of the observed indicators were non influencing factors to the prognosis of patients（short-term cure,illness protraction and death）.Conclusions When the prognosis was divided into clinical cure or death,disease condition,peripheral white blood cell count,whether there was ascites,prothrombin time,cholesterol,cholinesterase were closely related to the prognosis and could be used as a reference for making or adjusting the therapeutic plan.Because of the limitations of the study and individual differences,observation indexes of this study were unable to prejudge whether the prognosis of patients were short-term cure,protracted illness or death.