ALB和COP及CLI在百草枯中毒合并ARDS诊断及预后的意义

Clinical value of ALB and COP and CLI for predicting and prognosis of ARDS secondary to paraquat poisoning

目的:探讨百草枯中毒并发急性呼吸窘迫综合征(ARDS)患者血浆白蛋白(ALB)、血浆胶体渗透压(COP)、毛细血管渗漏指数(CLI)变化的特点以及对ARDS的诊断及预后预测价值。方法:回顾性分析收治的167例百草枯中毒患者,根据是否发生ARDS分为未发生ARDS组(82例)和发生ARDS组(85例),收集入ICU时(T1)及诊断ARDS时(T2)的血浆ALB、COP和CLI,比较T1和T2时间点各指标的变化,并采用受试者工作曲线(ROC)进行百草枯中毒合并ARDS诊断及预后效能评价。结果:百草枯合并ARDS组与非ARDS组T1时间点比较,T2时间点与T1时间点比较以及ARDS组中死亡组与存活组比较,ALB和COP均明显降低,CLI明显升高。ROC分析表明,T1时间点单一指标诊断ARDS的最大曲线下面积(AUC)为0.748(95%CI:0.674~0.822)(COP),联合诊断最大AUC为0.764(95%CI:0.694~0.835)(COP+CLI);T2时间点单一指标预测死亡的最大AUC为0.712(95%CI:0.604~0.820)(COP),联合预测最大AUC为0.725(95%CI:0.618~0.833)(ALB+COP)。结论:3种指标与百草枯中毒患者ARDS的发生及预后密切相关,特别是COP水平变化是诊断及评估预后不良的较好指标。

Objective:To investigate the changes of serum ALB,COP and CLI in acute respiratory distress syndrome(ARDS)secondary to paraquat poisoning,and to evaluate their clinical value in diagnosis and mortality predication of ARDS.Method:One hundred sixty-seven patients with PQ poisoning were devided into ARDS group(85 cases)and non-ARDS group(82 cases).ALB,COP and CLI at admission to ICU(T1)and the time-point when diagnosed for ARDS(T2)were collected.Receiver operating characteristic curve(ROC)was used to evaluate the performance of these indexes for the diagnosis and mortality prediction of acute paraquat-poisoned patients with ARDS.Result:The levels of ALB and COP were depressed,and CLI were elevated in ARDS patients compared with non-ARDS ones at T1 time-point.These three indexes had the same trend in T2 time-point compared with T1 time-point,and those of the dead patients were compared with those of survivors in ARDS group.ROC suggested that the best predictive AUCs of the early diagnosis in acute paraquat-poisoned patients with ARDS for single index and combination at T1 time-point were 0.748(95%CI:0.674-0.822)(COP)and 0.764(95%CI:0.694-0.835)(COP+CLI),respectively.Meanwhile the best predictive AUCs of 21-day mortality for single index and combination at T2 time-point were 0.712(95%CI:0.604-0.820)(COP)and 0.725(95%CI:0.618-0.833)(ALB+COP),respectively.Conclusion:ALB,COP and CLI are associated with the occurrence,development and poor prognosis in acute paraquat-poisoned patients with ARDS.It is possible that COP act as a significant diagnostic indicator for ARDS secondary to paraquat poisoning and as a predictive marker for poor prognosis of acute paraquat poisoning and as predictive markers for poor prognosis of acute paxaquat-poisoned patients with ARDS.