百草枯中毒肺损伤胸部CT影像学分级临床研究

Clinical research on lung CT imaging grading of lung injury caused by paraquat poisoning

目的 评价胸部CT影像学分级在急性百草枯中毒肺损伤临床诊治中的作用与价值.方法 选择海南省人民医院急诊科2008年1月至2018年9月收治的急性百草枯中毒住院患者91例作为研究对象.将患者肺损伤程度按胸部CT影像学严重度评分标准分为轻、中、重度;按《急性百草枯中毒专家共识》将患者按百草枯中毒程度不同分为轻、中、重和爆发型.比较急性百草枯中毒肺损伤患者不同胸部CT影像学严重度分级与病死率的差异;采用Kappa法分析肺损伤患者不同胸部CT影像学严重度分级与临床分型的一致性.结果 91例患者中,胸部CT影像学分级属轻、中、重度中毒患者分别为11、47、33例;临床分型轻、中、重、暴发型患者分别为14、36、37、4例.胸部CT影像学改变显示:肺叶磨玻璃影或渗出改变86例,肺纹理增粗84例,肺实变6例,肺纤维化11例,肺结构性改变6例,肺外损害43例.胸部CT肺损伤分级越严重,患者病死率越高;胸部CT影像学分级为重度患者的病死率明显高于轻度和中度者〔54.55%(18/33)比21.28%(10/47)、0(0/11),均P<0.05〕.Kappa法分析显示:胸部CT影像学严重度分级与临床分型存在高度的一致性(Kappa=0.570,P<0.001).结论 急性百草枯中毒胸部CT肺损伤严重度分级对治疗方案的选择与预后评价有一定指导作用.

Objective To evaluate the role and value of CT imaging grading in the diagnosis and treatment of acute lung injury caused by paraquat poisoning.Methods The 91 patients admitted to emergency department of the People's Hospital of Hainan Province due to acute paraquat poisoning from January 2008 to September 2018 were selected as research objects,and according to the criteria of severity of chest CT imaging,the lung injury was divided into 3 degrees:mild,moderate and severe.And then,according to Expert Consensus on Diagnosis and Treatment of Acute Paraquat Poisoning,the patients were divided into 4 types:mild,moderate,severe and explosive types.The severity classification of chest CT and the fatality rate were compared,and Kappa analysis was used to analyze the consistency of chest CT imaging severity classification and clinical classification.Results Among 91 cases,according to the classification of severity of chest CT imaging,11 were mild degree,47 were moderate degree,and 33 were severe degree.According to the clinical classification,14 were mild type,36 were moderate type,37 were severe type,and 4 were explosive type.Among 91 cases,according to the changes of lung CT imaging,86 showed ground-glass or exudative changes in pulmonary lobe,84 showed coarseness of lung markings,6 showed consolidation of lung,11 showed fibrosis of lung,6 showed pulmonary structural changes,and 43 showed extrapulmonary lesion.The more serious the CT lung injury grade was,the higher the fatality rate was.The fatality rate of severe patients was significantly higher than that of mild and moderate patients[54.55%(18/33)vs.21.28%(10/47),0(0/11),P<0.05].Kappa analysis showed that there was a high consistency between the severity classification of chest CT and clinical classification(Kappa=0.570,P<0.001).Conclusion The severity classification of lung injury chest CT plays a guiding role in the treatment plan selection and prognosis evaluation in acute paraquat poisoning lung injury.