肝损伤指标对急性百草枯中毒患者预后的评估价值

Evaluation of Liver Injury Indicators on the Prognosis of Patients with Acute Paraquat Poisoning

目的探讨肝损伤指标对急性百草枯中毒患者预后的评估价值。方法回顾性分析2013年3月至2017年4月郑州大学第一附属医院急诊科收治的479例急性百草枯中毒患者的临床资料,按中毒后30 d内预后分为存活组(284例)和病死组(195例)。采用多因素Logistic回归分析百草枯中毒死亡的独立危险因素,并绘制受试者工作特征(ROC)曲线评价相关因素的预测效果。结果多因素Logistic回归分析显示,服毒量、尿百草枯水平、直接胆红素、AST、ALT是急性百草枯中毒死亡的独立危险因素(均P<0.05)。ROC曲线显示,服毒量、尿百草枯水平、直接胆红素、AST、ALT预测急性百草枯中毒患者预后的ROC曲线下面积(AUC)分别为0.898、0.891、0.674、0.790、0.709。服毒量30 mL为判断预后的临界值(灵敏度85.57%,特异度79.23%),尿百草枯水平临界值为12.67μg·mL^-1(灵敏度84.02%,特异度78.37%),直接胆红素临界值为8.2μmol·L^-1(灵敏度38.46%,特异度92.23%),AST临界值为36 U·L^-1(灵敏度50.77%,特异度93.31%),ALT临界值为17 U·L^-1(灵敏度68.72%,特异度64.08%)。结论除服毒量、尿百草枯水平外,肝功能指标中直接胆红素、AST及ALT也是百草枯中毒预后较简单可靠的预测因子。

Objective To evaluate the value of liver injury indexes in the prognosis of patients with acute paraquat poisoning.Methods The clinical data of 479 patients with acute paraquat poisoning treated in the First Affiliated Hospital of Zhengzhou University from March 2013 to April 2017 were retrospectively analyzed.According to the prognosis within 30 d after poisoning,they were divided into survival group(284 cases)and death group(195 cases).Multivariate Logistic regression was used to find independent risk factors.The receiver operating characteristic(ROC)curves were drawn to evaluate the predictive effects of related factors.Results Multivariate Logistic regression analysis showed that the dose of toxin,urinary paraquat level,direct bilirubin,AST,and ALT were independent risk factors for death from acute paraquat poisoning(all P<0.05).ROC curves showed that the area under the ROC curve(AUC)for predicting the prognosis of patients with acute paraquat poisoning was 0.898,0.891,0.674,0.790,0.709,respectively.The dose of 30 mL was the critical value for judging the prognosis(sensitivity 85.57%,specificity 79.23%).The critical value of urinary paraquat level was 12.67μg·mL^-1(sensitivity 84.02%,specificity 78.37%).The critical value of direct bilirubin was 8.2μmol·L^-1(sensitivity 38.46%,specificity 92.23%).The AST threshold was 36 U·L^-1(sensitivity 50.77%,specificity 93.31%).The critical value of ALT was 17 U·L^-1(sensitivity 68.72%,specificity 64.08%).Conclusion In addition to the dose of poison and the level of urinary paraquat,direct bilirubin,AST and ALT are also simple and reliable predictors of prognosis of paraquat poisoning.