血清肌腱蛋白C评估急性百草枯中毒患者肺损伤

Evaluation of serum tenascin-C level for lung injury in acute paraquat poisoning patients

目的研究肌腱蛋白C(tenascin-C, TNC)在急性百草枯中毒患者血清中的表达水平及其对肺损伤程度和预后的评估作用。方法前瞻性收集2017年1月1日至2017年12月31日就诊于中国医科大学附属第一医院急诊科的急性百草枯中毒患者的临床资料,留取血清标本应用ELISA方法进行TNC浓度检测,根据患者服毒后28 d随访结果,分成存活组和死亡组,对两组患者入院时及入院后72 h内最差的基本临床数据和血清TNC浓度进行单因素分析,并将TNC血清浓度与肝功能、肾功能、血气分析结果等进行相关性分析,进一步应用Logistic回归分析,筛查预测患者死亡的独立危险因素并绘制受试者工作特征曲线(ROC)曲线,计算曲线下面积(AUC)。结果共有82例患者纳入此项研究,依据28 d随访结果,死亡组35例,存活组47例。入院首次pH、动脉氧分压(PaO2)、血肌酐(Cr)、血尿素氮(BUN)、谷丙转氨酶(ALT)、总胆红素(TBil)、血清淀粉酶(AMS)、TNC、肺CT阳性率等在两组间差异无统计学意义,而入院首次PaCO2、血乳酸(Lac)、尿百草枯浓度和血清TNC浓度在两组间差异有统计学意义。患者入院首次TNC浓度与入院72 h内最差的PaO2、pH、PaCO2、Lac以及肺CT阳性率具有较好的相关性,与PaO2显著相关(r=-0.801,P<0.01)。Logistic回归分析显示,入院首次血清TNC浓度是急性百草枯中毒患者预后的独立危险因素,AUC为0.895,cut-off值为41.9 ng/mL。结论急性百草枯中毒患者病程早期血清TNC表达水平能够预测患者肺损伤的程度并评估预后。

Objective To investigate the clinical implications of serum tenascin-C (TNC) levels for lung injury and the prognosis in acute paraquat (PQ) poisoning patients. Methods Clinical data of acute PQ poisoning patients hospitalized in Emergency Department of First Hospital of China Medical University from January 1 to December 31, 2017 were prospectively collected. Patients’ serum samples were obtained on admission and serum TNC levels were quantified by a commercially available enzyme-linked immunosorbent assays (ELISA) kit. Patients were followed up to 28 d after poisoning and divided into the survival and non-survival groups. The differences of clinical data together with serum TNC level between the two groups were analyzed by univariable analysis. The correlation between serum TNC level and liver function, renal function and artery blood gas results was analyzed. Logistic regression analysis was used for assessing the independent risk factors of death. ROC curves of related parameters were plotted and the area under the curve (AUC) was calculated. Results Eighty-two patients were enrolled in this study: 35 patients in the non-survival group and 47 patients in the survival group. There was no significant difference of data on admission between the two groups, including pH, PaO2, Cr, BUN, ALT, TBil, AMS, TNC, lung CT positive rate. But PaCO2, Lac, urine paraquat concentration and serum TNC level on admission were significantly different between the survival and non-survival groups. Furthermore, serum TNC level was correlated significantly with the worst PaO2 value, pH, and lung CT positive rate within 72 h from admission, especially the worst PaO2 value (r=-0.801, P<0.01). Logistic regression analysis showed that the serum TNC level on admission was an independent risk factor for the prognosis of acute PQ poisoning patients. The AUC was 0.895 and the cutoff value was 41.9 ng/mL. Conclusion The early serum TNC level in acute PQ poisoning patients can predict the degree of lung injury and evaluate the prognosis.