急性有机磷农药中毒患者NLR、ChE水平变化及与病情严重程度的关系

Changes of NLR and ChE levels in patients with acute organophosphorus pesticide poisoning and their relationship with severity of illness

目的探讨急性有机磷农药中毒(AOPP)患者中性粒细胞-淋巴细胞比值(NLR)、胆碱酯酶(ChE)水平变化及与病情严重程度的关系。方法选取2018年1月—2021年6月菏泽市立医院收治的227例AOPP患者作为研究组,另选取同时间段医院收治的125例健康志愿者作为对照组。比较两组患者血清NLR、ChE水平,根据病情严重程度将患者分为轻度AOPP患者、中度AOPP患者与重度AOPP患者,比较不同病情严重程度AOPP患者血清NLR、ChE水平及中毒指数,采用Spearson相关性分析法分析血清NLR、ChE水平与AOPP患者病情严重程度的相关性,收集患者的一般资料,采用Logistic回归分析法分析AOPP患者病情为重度的影响因素。结果两组年龄、性别、体质量指数(BMI)比较差异无统计学意义(P>0.05),研究组血清NLR水平比对照组高(P<0.05),研究组ChE活性比对照组低(P<0.05);不同病情严重程度AOPP患者血清NLR水平、ChE活性比较差异有统计差异(P<0.05);重度AOPP患者血清NLR水平高于中度、轻度AOPP患者(P<0.05),且中度AOPP患者血清NLR水平高于轻度AOPP患者(P<0.05);重度AOPP患者ChE活性低于中度、轻度AOPP患者(P<0.05),且中度AOPP患者ChE活性低于轻度AOPP患者(P<0.05);血清NLR水平与AOPP患者病情严重程度呈正相关(r=0.687,P=0.004),ChE活性与AOPP患者病情严重程度呈负相关(r=-0.526,P=0.009);重度AOPP患者急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、丙氨酸氨基转移酶(ALT)、血清NLR水平比轻中度AOPP患者高(P<0.05),重度AOPP患者白蛋白、ChE活性比轻中度AOPP患者低(P<0.05);Logistic回归分析结果显示,APACHEⅡ、血清NLR水平、ChE活性为AOPP患者病情为重度的影响因素(P<0.05)。结论血清NLR水平、ChE活性能够反映AOPP患者的病情严重程度,且APACHEⅡ评分、血清NLR水平、ChE活性为AOPP患者病情为重度的影响因素,临床应引起重视。

Objective To explore the relationship between the changes of neutrophil-lymphocyte ratio(NLR) and cholinesterase(ChE) levels and the severity of the disease in patients with acute organophosphorus pesticide poisoning(AOPP).Methods 227 AOPP patients were divided into 3 groups according to the severity of disease:mild AOPP group(n=9),moderate AOPP group(n=78), and severe AOPP group(n=90). Peripheral venous blood samples were collected on the next day of hospitalization. Automatic analyzer was used to calculate the NLR, and colorimetry was used to detect the serum ChE. 125 healthy volunteers admitted to the hospital at the same period were used as the control group with their blood samples collected on the very day when they underwent physical examination. Relative medical data and blood biochemical indexes were collected too. Pearson correlation analysis method was used to analyze the correlation of serum NLR and ChE with the severity of AOPP. Logistic regression analysis was used to analyze the influencing factors of the severity of AOPP.Results There was no significant difference in age, gender, body mass index(BMI) between the AOPP group and conterol group(all P>0.05). The serum NLR level of the AOPP group was significantly higher than that of the control group(P<0.05), and the ChE activity of the AOPP group was significantly lower than that of the control group(P<0.05). There were statistical differences in serum NLR levels and ChE activity in AOPP patients with different severity of illness(P<0.05). The serum NLR level of the patients with severe AOPP was significantly higher than those of the patients with moderate and mild AOPP(both P<0.05), and the serum NLR level of the patients with moderate AOPP was significantly higher than that of the patients with mild AOPP(P<0.05). The ChE activity in the patients with severe AOPP was significantly lower than those in the patients with moderate and mild AOPP(both P<0.05), and the ChE activity in the patients with moderate AOPP was significantly lower than that in the patients with mild AOPP(P<0.05). Serum NLR level was positively correlated with the severity of AOPP(r=0.687, P=0.004), and ChE activity was negatively correlated with the severity of AOPP(r=-0.526, P=0.009). The acute physiology and chronic health evaluation scoring system Ⅱ(APACHE Ⅱ) score, alanine aminotransferase(ALT), and serum NLR levels in patients with severe AOPP were higher than those in patients with mild to moderate AOPP(P<0.05), and the albumin level and ChE activities in the severe AOPP patients were significantly lower than those in the mild and moderate AOPP patients(P<0.05). Logistic regression analysis showed that APACHEⅡ score, serum NLR level, and ChE activity were the influential factors for the severity of AOPP(P<0.05).Conclusion Serum NLR level and ChE activity reflect the severity of AOPP, and APACHEⅡ score, serum NLR level, and ChE activity are factors that affect the severity of AOPP.