40例急性草甘膦中毒患者临床特点及预后影响因素分析

Analysis of clinical characteristics and prognostic factors in 40 cases of acute glyphosate poisoning

目的探讨急性草甘膦中毒患者临床特点及预后的影响因素,为急性草甘膦中毒的综合治疗与预后判断提供参考依据。方法于2020年8月,收集2014至2019年收治的40例急性草甘膦中毒患者临床资料,根据患者出院后90 d随访期内结局分为存活组(n=33)和治疗无效组(n=7),分析两组患者的临床特点,采用二元logistic回归分析患者预后的影响因素,并采用受试者工作特征(ROC)曲线评价入院时白细胞计数水平对急性草甘膦中毒患者预后的预测价值。结果40例急性草甘膦中毒患者平均年龄(57.70±19.72)岁,草甘膦口服量为100(50,200)ml,住院时间为4.0(1.0,5.0)d,病死率为17.5%(7/40),患者以消化道、呼吸道、心血管系统及神经系统症状为主要临床表现。logisitic回归分析显示,入院时白细胞计数水平是急性草甘膦中毒患者预后的影响因素(OR=1.148,95%CI:1.124~1.791,P=0.003)。ROC曲线结果表明,入院时白细胞计数水平判断急性草甘膦中毒患者预后的最佳诊断界值为14.65×109/L,曲线下面积(AUC)为0.9351,敏感度为100.00%,特异度为84.85%。结论入院时白细胞计数水平高是急性草甘膦中毒患者预后的危险因素,检测入院时白细胞计数水平对急性草甘膦中毒预后具有一定的预测价值。

Objective To explore the clinical characteristics and prognostic factors of patients with acute glyphosate poisoning,and to provide reference for the comprehensive treatment and prognosis judgment of acute glyphosate poisoning.Methods The complete hospitalized medical records data of 40 patients with acute glyphosate poisoning who were treated in the emergency department of Affiliated Hospital of Yangzhou University from 2014 to 2019 were collected in August 2020.According to the outcome during the follow-up period of 90 d after discharge from hospital,patients were divided into survival group(n=33)and treatment failure group(n=7).The clinical characteristics of the two groups were analyzed.The influencing factors of prognosis were analyzed by binary logistic regression,and the receiver operating characteristic(ROC)curve was used to evaluate the value of white blood cell count level at admission to the prognosis of patients with acute glyphosate poisoning.Results The average age of the 40 glyphosate poisoning patients was(57.70±19.72)years old,the oral dose was 100(50,200)ml,the hospital stay was 4.0(1.0,5.0)d,and the fatality rate was 17.5%(7/40).The main clinical manifestations were the symptoms of the digestive tract,respiratory tract,cardiovascular system and nervous system.Logistic regression showed that white blood cell level at admission was an influencing factor for the prognosis of patients with acute glyphosate poisoning(OR=1.148,95%CI:1.124-1.791,P=0.003).The ROC curve showed that the best diagnostic cut-off value of white blood cell level at admission to the prognosis of acute glyphosate poisoning was 14.65×109/L,the area under the curve(AUC)was 0.9351.The sensitivity was 100.00%,and the specificity was 84.85%.Conclusion High level of white blood cell at admission is a risk factor for the prognosis of acute glyphosate poisoning,and white blood cell level at admission has a certain predictive value for the prognosis of acute glyphosate poisoning.