白细胞计数早期评估急性百草枯中毒患者预后的价值

Prognostic value of white blood cell count in early evaluation of acute paraquat poisoning patients

目的:探讨急性百草枯中毒(APP)患者外周血白细胞(WBC)计数对于早期评估预后的价值。方法:回顾性分析202例中毒24h内APP患者入院时的一般资料、外周血WBC计数和血浆百草枯(PQ)浓度。计算PQ中毒严重指数(SIPP),根据SIPP将患者分为3组[A组:SIPP<10(h·mg·L^(-1));B组:10(h·mg·L^(-1))≤SIPP≤50(h·mg·L^(-1));C组:SIPP>50(h·mg·L^(-1))],比较各组间WBC计数及60d病死率,并分析WBC计数与SIPP的相关性,比较二者评估预后的价值。结果:死亡患者就诊时WBC计数高于存活患者[(20.31±9.84)×10~9/L vs.(11.08±4.98)×10~9/L,P<0.05],SIPP水平越高组WBC计数越高(P<0.05),WBC和SIPP具有相关性(r=0.323,P<0.05),WBC和SIPP预测死亡的ROC曲线下面积分别为0.801和0.948(P<0.05),WBC截断值为14.37×10~9/L时预测死亡的敏感度和特异度分别为70.30%和80.20%,SIPP截断值为7.61(h·mg·L^(-1))时预测死亡的敏感度和特异度分别为91.09%和88.12%。结论:外周血WBC计数对于早期评估APP预后具有一定的临床价值,但需结合其他指标(如乳酸)综合判断。

Objective：To discuss prognostic value of peripheral blood white blood cell （WBC） count in early e- valuation of acute paraquat poisoning （APP） patients. Method： We reviewed the general data, peripheral blood WBC counts and plasma paraquat concentrations of 202 APP patients poisoning in 24 hours. Calculated the Severity Index of Paraqaut Poisoning （SIPP）,then divided the patients into three groups on the basis of SIPP [Group A： SIPP〈10（h·mg·L^-1） ,Group B：10≤SIPP≤50（h·mg·L^-1） ,Group C：SIPP〉50（h·mg·L^-1）],compared the WBC count and 60d mortality rate among each group. And analyzed the correlation between the WBC count and SIPP,then compare the value for prognosis. Result：The WBC count of dead was higher than the survival on arrival [（20.31±9.84）×10^9/L vs. （11.08±4.98）×10^9/L, P〈0. 05] ,and the higher SIPP level group had the higher WBC count （P〈0.05） ,WBC count was correlated positively with SIPP （r=0.323,P〈0.05）. The area under the Receiver Operating Characteristic （ROC） curve of WBC count and SIPP were 0. 801 and 0. 948, respectively （P〈0.05）. When the cut-off value was 14.37×10^9/L, the sensitivity and specificity of WBC count for predict death were 70.30% and 80.20%,respectively. And when the cut-off value was 7.61（h·mg·L^-1） ,the sensitivity and specificity of SIPP for predict death were 91.09% and 88.12%, respectively. Conclusion： Peripheral WBC count have clinical value for early evaluation of APP patients,but should be combined with other indicators （such as lactic acid） for comprehensive judgment.