210例急性毒蕈中毒患者的临床特征及死亡危险因素分析

Analysis on clinical features and risk factors of death in 210 patients with acute mushroom poisoning

目的分析急性毒蕈中毒患者的临床特征，并探讨其死亡危险因素。方法回顾性分析2013年7月至2016年12月西南医科大学附属医院收治的随访超过6个月的210例急性毒蕈中毒患者的临床资料，包括性别、年龄、住院时间、毒蕈情况、潜伏期、临床表现、实验室指标和预后。根据预后将患者分为存活组和死亡组，分析两组患者的临床特征和器官或系统受累情况；采用单因素和多因素Logistic回归分析筛选急性毒蕈中毒患者的死亡危险因素。结果210例患者均纳入最终分析，存活组172例（占81．9％），死亡组38例（占18．1％），以潜伏期为6～24h的患者病死率最高[占15．2％（32／210）]。所有患者食用毒蕈的颜色以白、红、黄居多，进食量20～500g。超过85％的患者有胃肠道反应，器官损害以肝脏为主[58．1％（122／210）]，伴心脏和神经系统损害者的病死率更高[分别为61．4％（27／44）、61．3％（19／31）]，且受累器官或系统数量越多，病死率越高。单因素分析显示，潜伏期≥6h、白细胞计数（WBC）≥12×10^9／L、丙氨酸转氨酶（ALT）≥200U／L、天冬氨酸转氨酶（AST）≥200U／L、乳酸脱氢酶（LDH）≥500U／L、凝血酶原时间（PT）≥20s、活化部分凝血活酶时间（APTT）≥40S、凝血酶原活动度（PTA）≤60％、血Na＋≤135mmol／L、肌酸激酶同工酶（CK—MB）≥5μg/L和肌红蛋白（Mb）≥100μg／L是急性毒蕈中毒患者死亡的危险因素；多因素Logistic回归分析显示，当APTT≥40s时死亡风险最大，可导致患者死亡风险增加5．35倍[优势比（OR）=6．35，95％可信区间（95％CI）=1．24—32．44]，提示APTT是急性毒蕈中毒患者死亡的独立危险因素。结论急性毒蕈中毒患者病死率高，器官损害以肝脏为主；潜伏期及WBC、ALT、AST、LDH、PT、APTT、PTA、Na＋、CK—MB和Mb等实验室指标是急性毒蕈中毒患者死亡的危险因素，以APTT≥40s时死亡风险最大。

Objective To analyze the clinical features and risk factors of death in patients with acute mushroom poisonings. Methods The clinical data of 210 patients with acute mushroom poisoning admitted to the Affiliated Hospital of Southwest Medical University from July 2013 to December 2016 and received follow-up for at least 6 months were retrospectively analyzed. The data included gender, age, hospitalization time, toadstool features, incubation period, clinical performance, laboratory indicators, and prognosis. According to the prognosis, the patients were divided into survival group and non-survival group, the clinical characteristics and organ or system involvement of the two groups were analyzed, and the risk factors of death in patients with acute mushroom poisoning were explored by univariate and Logistic regression analysis. Results All 210 patients were enrolled in the final analysis, with 172 patients （81.9%） in survival group, and 38 （18.1%） in non-survival group. Patients with an incubation period of 6-24 hours had the highest mortality [15.2% （32/210）]. Most toadstools were in white, red or yellow, with an intake of 20-500 g. More than 85% of patients had gastrointestinal reactions, and liver damage was the most common [58.1% （122/210）] in all patients. The patients with heart and nervous system damage had higher mortality [61.4% （27/44） and 61.3% （19/31）], and the more organs or systems involved, the higher the mortality was. Univariate analysis showed that incubation period/〉 6 hours, white blood cell （WBC） /〉 12 X 109/L, alanine aminotransferase （ALT） ≥200 U/L, aspartate aminotransferase （AST）≥200 U/L, lactate dehydrogenase （LDH）≥500 U/L, prothrombin time （PT）≥20 s, activated partial thrombin time （APTF） ≥40 s, prothrombin activity （PTA）≤60%, Na＋≤135 mmol/L, MB isoenzyme of creatine kinase （CK-MB）≥5μg/L and myoglobin （Mb）≥100μg/L were the risk factors of death in patients with acute mushroom poisoning. Multiple factors Logistic regression analysis showed that APTT I〉 40 s had the greatest lethal risk and could increase the risk of death by 5.35 times [odds ratio （OR） = 6.35, 95% confidence interval （95%CI） = 1.24-32.44], indicating that APTT was an independent risk factor of death in patients with acute mushroom poisoning. Conclusions The mortality of acute mushroom poisoning was high, and liver was the mainly involved organ. The incubation period, WBC, ALT, AST,LDH, PT, APTT, PTA, Na＋, CK-MB and Mb could be early indicators to evaluate the prognosis in patients with acute mushroom poisoning, and patients with APTT≥40 s had the greatest lethal risk.