毒蛇咬伤患者血清生化指标变化及其与预后的相关性

Changes of serum biochemical indexes and their correlation with prognosis in patients with snakebite

目的探讨毒蛇咬伤患者血清生化指标变化及其与预后的相关性。方法选取汉中市中心医院2018年6月至2021年6月收治的158例毒蛇咬伤患者作为研究组,另选取同期健康体检者60例作为对照组。比较两组受检者及不同病情严重程度、不同预后毒蛇咬伤患者的血清C反应蛋白(CRP)、白细胞介素(IL-6)、肌酐(Cr)、谷丙转氨酶(ALT)水平,采用Spearman相关性系数分析血清CRP、IL-6、Cr、ALT与病情严重程度的相关性,采用受试者工作曲线(ROC)及曲线下面积(AUC)分析血清CRP、IL-6、Cr、ALT对预后的评估价值。结果研究组患者的血清CRP、IL-6、Cr、ALT水平分别为(23.89±5.47)mg/L、(30.58±6.62)pg/mL、(127.31±20.24)μmol/L、(82.15±15.86)U/L,明显高于对照组的(2.05±0.42)mg/L、(7.21±1.58)pg/mL、(64.37±4.61)μmol/L、(21.74±5.93)U/L,差异均有统计学意义(P<0.05);危重型组患者的血清CRP、IL-6、Cr、ALT水平明显高于重型组及轻型组,重型组患者的血清CRP、IL-6、Cr、ALT水平明显高于轻型组,差异均有统计学意义(P<0.05);经Spearman相关性分析结果显示,血清CRP、IL-6、Cr、ALT水平与毒蛇咬伤患者病情严重程度均成正相关(r=0.763、0.721、0.796、0.813,P<0.05);未痊愈组患者的血清CRP、IL-6、Cr、ALT水平分别为(30.62±3.19)mg/L、(38.01±3.57)pg/mL、(159.13±12.24)μmol/L、(105.87±11.01)U/L,明显高于痊愈组的(22.85±2.43)mg/L、(29.44±3.04)pg/mL、(122.43±16.62)μmol/L、(78.51±8.38)U/L,差异均有统计学意义(P<0.05);经ROC分析结果显示,血清CRP、IL-6、Cr、ALT联合评估毒蛇咬伤患者预后的AUC为0.910,高于四者单独评估的0.711、0.705、0.685、0.733(P<0.05)。结论毒蛇咬伤患者血清CRP、IL-6、Cr、ALT呈升高趋势,四者与病情严重程度呈正相关,可作为临床评估毒蛇咬伤患者预后的重要指标。

Objective To explore the changes of serum biochemical indexes and their correlation with prognosis in patients with snakebite.Methods A total of 158 patients with snakebite admitted to Hanzhong Central Hospital between June 2018 and June 2021 were enrolled as the study group,while other 60 healthy controls during the same period were enrolled as the control group.The levels of serum C-reactive protein(CRP),interleukin(IL-6),creatinine(Cr),and alanine aminotransferase(ALT)were compared between the two groups and among patients with different disease severity and prognosis.The correlation between serum CRP,IL-6,Cr,ALT and disease severity was analyzed by Spearman correlation coefficient.The prognostic value of serum CRP,IL-6,Cr,and ALT was analyzed by receiver operating characteristic(ROC)curve and area under the curve(AUC).Results The levels of serum CRP,IL-6,Cr,and ALT in study group were(23.89±5.47)mg/L,(30.58±6.62)pg/mL,(127.31±20.24)μmol/L,and(82.15±15.86)U/L,significantly higher than(2.05±0.42)mg/L,(7.21±1.58)pg/mL,(64.37±4.61)μmol/L,(21.74±5.93)U/L in the control group(P<0.05).The levels of serum CRP,IL-6,Cr,and ALT were the highest in critical group,followed by severe group and then mild group,with statistically significant differences among the three groups(P<0.05).Spearman correlation analysis showed that levels of serum CRP,IL-6,Cr,and ALT were positively correlated with disease severity in patients with snakebite(r=0.763,0.721,0.796,0.813,P<0.05).The levels of serum CRP,IL-6,Cr,and ALT in non-healing group were(30.62±3.19)mg/L,(38.01±3.57)pg/m L,(159.13±12.24)μmol/L,and(105.87±11.01)U/L,significantly higher than(22.85±2.43)mg/L,(29.44±3.04)pg/m L,(122.43±16.62)μmol/L,(78.51±8.38)U/L in healing group(P<0.05).ROC curve analysis showed that AUC of CRP combined with IL-6,Cr,and ALT for assessing prognosis of patients with snakebite was 0.910,significantly greater than that of them alone(0.711,0.705,0.685,0.733,respectively),P<0.05.Conclusion The levels of serum CRP,IL-6,Cr,and ALT increase in patients with snakebite,which are positively correlated with disease severity.The four indexes can be applied as important clinical evaluation indexes for prognosis of patients with snakebite.