血浆秋水仙碱浓度与中毒时间乘积对秋水仙碱中毒患者预后的预测价值

Predictive value of the product of plasma colchicine concentration and poisoning time for the prognosis of colchicine poisoning patients

目的探讨血浆秋水仙碱浓度与中毒时间乘积(浓度时间乘积)在秋水仙碱中毒患者预后中的预测价值, 为早期预后评估提供依据。方法于2021年10月, 收集2017年1月至2021年9月温州医科大学附属第一医院收治的秋水仙碱中毒患者的临床资料, 包括患者性别、年龄、口服秋水仙碱剂量、中毒时间等一般资料, 以及患者入院后首次实验室检测指标和血浆秋水仙碱浓度, 根据患者预后分为存活组和死亡组, 比较两组患者入院血浆秋水仙碱浓度、血常规、血生化、凝血功能、血气分析等临床指标的差异及其对患者预后的预测价值。结果共纳入23例秋水仙碱中毒患者, 年龄20~85岁, 其中存活15例(65.22%), 死亡8例(34.78%), 入院首次血浆秋水仙碱浓度为0.42~53.61 ng/ml, 浓度时间乘积10.08~2 147.04 h·ng/ml。与存活组比较, 死亡组患者入院首次血浆秋水仙碱浓度和浓度时间乘积明显升高, 差异均有统计学意义(P<0.05)。单因素logisitic回归分析, 浓度中毒时间乘积>132.48 h·ng/ml、C-反应蛋白、D二聚体、剩余碱绝对值升高是秋水仙碱中毒患者预后的危险因素(OR=12.000, 95%CI:1.118~128.836;OR=1.053, 95%CI:1.009~1.098;OR=1.219, 95%CI:1.039~1.429;OR=1.360, 95%CI:1.044~1.773;P<0.05);凝血酶原活动度升高是秋水仙碱中毒患者预后的保护因素(OR=0.941, 95%CI:0.892~0.993;P<0.05)。ROC曲线分析提示, 浓度时间乘积、C-反应蛋白、剩余碱绝对值、D二聚体预测秋水仙碱中毒患者预后的曲线下面积分别为0.918、0.888、0.867、0.837, 凝血酶原活动度预测秋水仙碱中毒患者预后的曲线下面积为0.788(P<0.05)。结论首次血浆秋水仙碱浓度与中毒时间乘积与秋水仙碱中毒患者预后密切相关, 可作为早期评估中毒患者预后的预测因子。

Objective To investigate the predictive value of the product of first plasmacolchicine concentration and poisoning time for the prognosis of colchicine poisoning patients,and to provide a basis for early prognosis assessment.Methods October 2021,patients with colchicine poisoning admitted in the First Affiliated Hospitol of Wenzhou Medical University from January 2017 to September 2021 were collected,including general information such as patient gender,age,oral colchicine dose,poisoning time,the first laboratory test index andplasma colchicine concentration after admission.The patients were divided into survival group and death group according to their prognosis.The differences in clinical indicators such as admission plasma colchicine concentration,blood routine,blood biochemistry,coagulation function,and blood gas analysis were compared between the two groups,and their predictive value for the prognosis of patients were analyzed.Results A total of 23 patients with colchicine poisoning,aged 20-85 years,were included in this study,of which 15 cases(65.22%)survived and 8 cases(34.78%)died.The first plasma colchicine concentration at admision were 0.42-53.61 ng/ml.The plasma colchicine concentration and the concentration-time product were 10.08-2147.04 h·ng/ml.Compared with the survival group,the plasma colchicine concentration and the concentration-time product in the death group were significantly increased,and the differences were statistically significant(P<0.05).Univariate logistic regression analysis showed that first plasma concentration and poisoning time>132.48 h·ng/ml,high C-reactive protein,high D-dimer,high absolute value of BE were the risk factors for the prognosis of patients with colchicine poisoning(OR=12.000,95%CI:1.1181-128.836;OR=1.053,95%CI:1.009-1.098;OR=1.219,95%CI:1.039-1.429;OR=1.360,95%CI:1.1.044-1.773;P<0.05).High prothrombin time activity was protective factor affecting the prognosis of colchicine poisoning patients(OR=0.941,95%CI:0.892~0.993;P<0.05).ROC curve analysis showed that the areas under the curves of first plasma concentration and poisoning time,C-reactive protein,absolute value of BE,D-dimer for predicting the prognosis of patients with colchicine poisoning were 0.918,0.888,0.867,0.837,respectively,and the areas under the curves of prothrombin time activityfor predicting the prognosis of patients with colchicine poisoning was 0.788(P<0.05).Conclusion The product of the first plasma colchicine concentration at admission and poisoning time is closely related to the prognosis of patients with colchicine poisoning,it can be used as a predictor for early evaluation of the prognosis of poisoned patients.