农药中毒继发急性肾损伤的危险因素

Risk factors associated with acute kidney injury caused by pesticide poisoning

目的分析农药中毒患者的临床特征并探讨其发生急性肾损伤(AKI)的危险因素。方法于2020年9月,回顾性分析西南医科大学附属医院肾病内科2018年9月至2020年8月收治的155例农药中毒患者的临床资料。按照是否发生AKI将患者分为AKI组(44例)和非AKI组(111例),分析两组患者的临床特征、器官或系统受累情况以及辅助检查结果;采用logistic回归法分析农药中毒患者发生AKI的危险因素。结果引起中毒的农药种类主要包括除草剂、杀虫剂以及生物化学农药等;与非AKI组比较,AKI组患者行血液净化治疗和入ICU监护治疗比例均较高(P<0.05),且更易发生急性呼吸衰竭、肺间质纤维化、心肌损伤、多器官功能障碍综合征(MODS)、急性胰腺炎和凝血异常(P<0.05);AKI组病死率(18.2%,8/44)明显高于非AKI组(0.9%,1/111)(P<0.05)。单因素分析显示,中毒至就诊时间>6 h、白细胞计数、中性粒细胞、丙氨酸氨基转氨酶、天冬氨酸氨基转氨酶、高敏肌钙蛋白T、肌红蛋白、肌酸激酶同工酶偏高均是农药中毒患者发生AKI的危险因素(P<0.05);多因素logistic回归分析显示,中毒至就诊时间>6 h是农药中毒患者发生AKI的独立危险因素(P<0.05)。结论农药中毒患者继发AKI病死率较高,应关注患者中毒至就诊时间、炎症状态以及肝脏和心肌功能的变化。

Objective To analyze the clinical characteristics of pesticide poisoning patients and explore the risk factors of acute kidney injury(AKI).Methods In September 2020,the clinical data of 155 patients with pesticide poisoning in the department of nephropathy,the Affiliated Hospital of Southwest Medical University from September 2018 to August 2020 were retrospectively analyzed.The patients were divided into AKI group(44 cases)and non AKI group(111 cases)according to the occurrence of AKI.The clinical characteristics,organ or system involvement and auxiliary examination results of the two groups were analyzed.Logistic regression was used to analyze the risk factors of AKI in patients with pesticide poisoning.Results The types of pesticides causing poisoning mainly included herbicides,insecticides and biochemical pesticides.Compared with non AKI group,patients in AKI group had higher proportion of blood purification treatment and ICU monitoring treatment(P<0.05),and were more likely to be complicated with acute respiratory failure,pulmonary fibrosis,myocardial injury,multiple organ dysfunction syndrome(MODS),acute pancreatitis and coagulation abnormalities(P<0.05).The mortality of AKI group(18.2%,8/14)was significantly higher than that of non AKI group(0.9%,1/111)(P<0.05).Univariate analysis showed that the time from poisoning to treatment>6 h,high WBC count,neutrophil count,alanine aminotransferase,aspartate aminotransferase,high sensitive troponin T,myoglobin and creatine kinase isoenzyme were the risk factors of AKI in patients with pesticide poisoning(P<0.05).Multivariate logistic regression analysis showed that the time from poisoning to treatment>6 h was an independent risk factor for AKI in patients with pesticide poisoning(P<0.05).Conclusion The mortality of AKI secondary to pesticide poisoning is high.Attention should be paid to the time from poisoning to treatment,inflammatory state and changes of liver and myocardial function.