肺磨玻璃体积占比对急性百草枯中毒患者预后的判断价值

Prognostic value of lung ground glass opacities volume ratio in patients with acute paraquat poisoning

目的通过对急性百草枯(paraquat,PQ)中毒患者不同时间点高分辨CT(high resolution CT,HRCT)肺磨玻璃影(ground glass opacities,GGOs)体积占比(volume%,V%GGOs)的比较,分析其对急性PQ中毒患者早期预后判断的价值。方法前瞻性分析中国武警特色医学中心呼吸与重症医学科2017年6月至2018年12月收治的PQ中毒患者。根据中毒后90 d随访结果分成生存组及死亡组,应用三维重建技术计算两组患者在中毒后第3、5、7天时V%GGOs变化。两组间性别、年龄、中毒时间比较采用卡方检验及单因素方差分析。两组不同时间点V%GGOs比较采用成组t检验。绘制受试者工作特征曲线(ROC),判断该指标在上述不同时间点对PQ中毒患者预后的指导意义。结果共有89例PQ中毒患者纳入研究,其中生存组49例,死亡组40例。入院时两组患者在性别、年龄、中毒时间、氧合指数、平均动脉压、总胆红素、血尿素氮、谷丙转氨酶、谷草转氨酶间的比较差异无统计学意义(均P>0.05)。死亡组入院时血中PQ浓度(mg/L)明显高于生存组(6.35±0.51 vs 3.49±0.21,P=0.013)。入院后第3、5、7天死亡组V%GGOs均明显高于生存组(3 d:0.062±0.020 vs 0.049±0.007,P=0.013;5 d:0.292±0.130 vs 0.123±0.044,P<0.01;7 d:0.334±0.116 vs 0.138±0.034,P=0.019)。ROC曲线下面积显示中毒后第7天V%GGOs判断预后AUC为0.967,阈值0.16时灵敏度100%,特异度83.33%,但时间点偏晚。中毒后第5天V%GGOs判断预后AUC为0.842,阈值0.14时灵敏度82.35%,特异度89.47%。中毒后第3天V%GGOs判断预后AUC为0.708,阈值0.05时灵敏度55.00%,特异度78.95%,此时无论是灵敏度还是特异度均较第5、7天低。结论V%GGOs可用来评估急性PQ中毒患者预后,最佳时间点为中毒后第5天。

Objective By comparing the volume%(V%GGOs)of ground glass opacities(GGOs)in high resolution CT(HRCT)of patients with acute paraquat(PQ)poisoning at different time points,its value in the early prognosis of patients with PQ poisoning was analyzed.Methods The data of patients with PQ poisoning admitted to Department of Respiratory and Critical Care Medicine of Chinese Armed Police Forces from June 2017 to December 2018 were prospectively analyzed.According to the followup results after poisoning at 90 days,the patients were divided into the survival group and death group.Three-dimensional reconstruction technology was used to calculate the change of V%GGOs on the 3rd,5th,and 7th day after poisoning.Chi-square test and One-Way ANOVA of variance were used to compare sex,age,and time of poisoning between the two groups.The Student's t test was used to compare V%GGOs between the two groups at different time points.The receiver operating characteristic curve(ROC)was used to determine the guiding significance of the indicator on the prognosis of patients with PQ poisoning at different time points.Results A total of 89 patients with PQ poisoning were included in the study,49 in the survival group and 40 in the death group.There were no statistical differences between the two groups of patients in sex,age,poisoning time,oxygenation index,mean arterial pressure,total bilirubin,blood urea nitrogen,alanine aminotransferase,and aspartate aminotransferase at admission(all P>0.05).The blood PQ concentration(mg/L)in the death group was significantly higher than that in the survival group(6.35±0.51 vs 3.49±0.21,P=0.013).On the 3rd,5th and 7th day after admission,the V%GGOs was significantly higher than that in the survival group(3rd day:0.062±0.020 vs 0.049±0.007,P=0.013;5th day:0.292±0.130 vs 0.123±0.044,P<0.01;7th day:0.334±0.116 vs 0.138±0.034,P=0.019).The area under the ROC curve showed that the prognosis AUC of the 7th day V%GGOs after poisoning was 0.967,the sensitivity was 100%and the specificity was 83.33%when the threshold was 0.16,but the time point was late.On the 5th day after poisoning,the V%GGOs judged the prognosis AUC was 0.842,the sensitivity was 82.35%and the specificity was 89.47%when the threshold was 0.14.On the 3rd day after poisoning,the V%GGOs judged the prognosis AUC was 0.708,the sensitivity was 55.00%and the specificity was 78.95%when the threshold was 0.05.At this time,the sensitivity and specificity were lower than those on the 5th and 7th day.Conclusions The proportion of ground glass opacity volume in patients with PQ poisoning can be used to evaluate their prognosis,and the best time point is the 5th day after poisoning.