毒蕈中毒住院患者临床特征及死亡危险因素分析

Analysis of clinical characteristics and death risk factors of hospitalized patients with toadstool poisoning

目的分析毒蕈中毒住院患者的临床特征并探讨其死亡危险因素。方法回顾性分析2013年1月至2021年1月湖南省某三甲医院收治的毒蕈中毒住院患者的基本情况及临床症状等资料,根据预后分为存活组与死亡组,采用单因素和多因素二元Logistic回归分析方法,分析两组毒蕈中毒住院患者的临床特征以及影响死亡预后的危险因素。结果本回顾性研究纳入的115例毒蕈中毒患者中,死亡15例[13.04%(15/115)]。与存活组相比,死亡组患者平均年龄为(60.67±8.51)岁;潜伏期以6~24h的发生率高;毒蕈类型以鹅膏菌属为主;中毒类型以肝损型为主;治疗前的实验室指标肝功能(ALT/AST/TB/LDH)和凝血功能(PT/APTT)指标值远高于正常范围;临床表现中以消化道出血、黄疸、感染和胸闷乏力的比率高,且差异均具有统计学意义(P<0.05)。单因素Logistics回归分析结果显示,年龄≥60岁,鹅膏菌属,肝损型中毒,肝功能指标(ALT≥200U/L、AST≥200U/L、TB≥30umol/L、LDH≥500U/L),凝血功能指标(PT≥20s、APTT≥40s),消化道出血、黄疸、感染和胸闷乏力为毒蕈中毒患者死亡的危险因素。多因素二元Logistics回归分析结果进一步显示,鹅膏菌属、凝血酶原时间(PT)≥20s、消化道出血、黄疸和感染是影响毒蕈中毒住院患者死亡预后的独立危险因素。结论鹅膏菌属、PT≥20s、消化道出血、黄疸和感染是毒蕈中毒患者死亡的独立危险因素,肝功能受损和凝血功能障碍可作为毒蕈中毒住院患者病情危重程度的关键评价指标。

Objective To analyzed the clinical characteristics and the risk factors of death in patients with toadstool poisoning.Methods The date of the basic information and clinical symptoms of patients with toadstool poisoning admitted to a Third-Class Hospital in Hunan Province from January 2013 to January 2021 were retrospectively analyzed.According to the prognosis,the patients was divided into survival group and death group.Univariate and multivariate binary Logistic regression were used to analyze the clinical characteristics and risk factors influencing the death prognosis of hospitalized patients with toadstool poisoning in two groups.Results All 115 patients with toadstool poisoning included in this retrospective study,with 15 patients in death group[13.04%(15/115)].Contrast to the survival group,the average age of patients in the death group was 60.67±8.51.For the death group,patients with an incubation period of 6-24 hours had the highest incidence,amanita was the main type of toadstool and liver damage was the main type of poisoning.the indexes of liver function(ALT/AST/TB/LDH)and coagulation function(PT/APTT)were much higher than the normal range for laboratory indicators before treatment.Among the clinical manifestations,the rates of gastrointestinal bleeding、jaundice、infection、chest distress and fatigue of the death group were higher than the survival group,and the all differences were statistically significant(P<0.05).Logistic regression(single factor)analysis results showed that age≥60 years、toadstool type of amanita、poisoning type of liver damage、the indicators of liver function(ALT/AST≥200 U/L,TB≥30 umol/L,LDH≥500 U/L)and coagulation function(PT≥20 s,APTT≥40 s),the clinical symptoms of gastrointestinal bleeding、jaundice、infection and chest tightness and fatigue were risk factors for death of patients with toadstool poisoning.Logistic regression(multivariate)analysis further showed that amanita、gastrointestinal prothrombin time(PT)≥20 s、bleeding、jaundice and infection were independent risk factors affecting the prognosis of death in patients with toadstool poisoning.Conclusions Amanita、PT≥20 s、gastrointestinal bleeding、jaundice and infection were risk factors for death of patients with toadstool poisoning,liver function impairment and coagulation dysfunction could be used as key evaluation indexes for severity of patients with toadstool poisoning.