急性有机磷中毒患者血清ChE、肝酶、miR-214表达与APACHEⅡ分值关系及其预后预测意义

Relationship between serum ChE,liver enzyme,miR-214 expression and APACHEⅡscore in patients with acute organophosphate poison-ing and its prognostic significance

目的探讨急性有机磷中毒(acute organophosphorus pesticide poisoning,AOPP)患者血清胆碱酯酶(cholin⁃esterase,ChE)、肝酶[丙氨酸转氨酶(alanine aminotransferase,ALT)、天冬氨酸转氨酶(aspartate aminotransferase,AST)]、微小RNA-214(miR-214)表达与急性病理生理和慢性健康评分Ⅱ(acute physiologyand chronic health evaluation,APACHEⅡ)分值关系及其预后预测意义。方法选取2015年4月-2020年3月衡水市人民医院80例AOPP患者作为研究对象,根据患者预后分组,死亡组16例,存活组64例。比较两组临床资料、血清ChE、ALT、AST、miR-214表达水平及不同APACHEⅡ分值患者血清指标水平,分析血清指标与APACHEⅡ分值相关性及血清指标、APACHEⅡ分值与死亡相关性,采用受试者工作特征(receiver operating characteristic curve,ROC)曲线分析血清指标、APACHEⅡ评分对AOPP预后不良的预测价值。结果不同预后患者在中毒至入院时间、有机磷摄入量、白细胞(WBC)、中性粒细胞(NC)、淋巴细胞(LC)、中性粒细胞与淋巴细胞比值(NLR)、白蛋白、APACHEⅡ评分、血清ChE、肝酶(ALT、AST)、miR-214表达方面相比,差异有统计学意义(P<0.05);APACHEⅡ高评分组ChE水平低于低评分组,ALT、AST、miR-214水平高于低评分组,差异有统计学意义(P<0.05);AOPP患者ChE与APACHEⅡ分值呈负相关关系,ALT、AST、miR-214水平与APACHEⅡ分值呈正相关关系(P<0.05);将中毒至入院时间、有机磷摄入量、WBC、NC、LC、NLR、白蛋白等其他因素控制后,APACHEⅡ评分、血清ChE、肝酶(ALT、AST)、miR-214仍与AOPP患者死亡显著相关(P<0.05);ROC曲线显示,血清指标、APACHEⅡ评分预测AOPP死亡的价值AUC均较高,尤以联合预测最高,达0.877。结论AOPP患者血清ChE、肝酶(ALT、AST)、miR-214表达与APACHEⅡ分值相关,且均具有良好预测价值,联合检测可为病情程度评估及预后预测提供有效参考。

Objective To investigate the relationship between the expression of serum cholinesterase(ChE),liver en‐zymes[alanine aminotransferase(ALT),aspartate aminotransferase(AST)],microRNA-214(miR-214)and acute patho‐physiology and chronic health scoreⅡ(APACHEⅡ)score in patients with acute organophosphorus pesticide poison‐ing(AOPP)and its prognostic significance.Methods A total of 80 AOPP patients in our hospital from April 2015 to March 2020 were selected as the study subjects.According to the prognosis of the patients,16 cases as died group and 64 as cases survived group.The clinical data,serum ChE,ALT,AST,miR-214 expression levels and serum index lev‐els of patients with different APACHEⅡscores were compared between the two groups.The correlation between serum indexes and APACHEⅡscores and the correlation between serum indexes,APACHEⅡscores and death were ana‐lyzed.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum indexes and APACHEⅡscores for poor prognosis of AOPP.Results In terms of the time from poisoning to admission,the intake of organic phosphorus,WBC,NC,LC,NLR,albumin,APACHEⅡscore,serum ChE,liver enzymes(ALT,AST),and miR-214 expression in patients with different prognosis,the differences were statistically significant(P<0.05).The ChE level of the APACHEⅡhigh score group was lower than that of the low score group,and the levels of ALT,AST,and miR-214 were higher than those of the low score group,the difference was statistically significant(P<0.05).ChE in AOPP patients was negatively correlated with APACHEⅡscores,and ALT,AST,miR-214 levels were positively cor‐related with APACHEⅡscores(P<0.05).After controlling the time from poisoning to hospital admission,organophos‐phate intake,WBC,NC,LC,NLR,albumin and other factors,APACHEⅡscore,serum ChE,liver enzymes(ALT,AST),miR-214 were still significantly related to the death of AOPP patients(P<0.05).The ROC curve showed that the serum index and APACHEⅡscore had a high value in predicting AOPP death,and the AUC was the highest in combi‐nation prediction,reaching 0.877.Conclusion The expressions of serum ChE,liver enzymes(ALT,AST)and miR 214 in AOPP patients are correlated with the APACHEⅡscore,and all have good predictive value.Combined detec‐tion can provide an effective reference for the evaluation of disease severity and prognosis prediction.