连二亚硫酸钠还原法在敌草快中毒诊疗中的临床价值

Clinical value of sodium dithionite reduction method in the diagnosis and treatment of diquat poisoning

目的探索用连二亚硫酸钠还原法进行尿液半定量比色在敌草快中毒诊疗中的临床价值。方法回顾性分析2020年12月3日至2022年11月23日在本院救治的49例急性敌草快中毒患者资料,观察尿比色结果与血浆敌草快浓度相关性;评价尿比色结果对靶器官损伤、及预后的预测价值。结果尿比色结果与血浆敌草快浓度具有显著相关性,相关系数r=0.89,P<0.01;尿比色结果预测消化道、肝脏、肾脏、及中枢神经系统损伤的临界值分别为2.5、3.5、3.5、5.5,其中尿比色结果预测消化道损伤的敏感性最高[AUC 0.93(95%CI:0.89~1.00)];尿比色结果预测死亡结局的临界值为4.5,阳性预测值为64.2%,阴性预测值为95.2%。结论尿半定量比色法可用于快速预测入院时血浆敌草快浓度范围;尿比色结果也可有效预测敌草快中毒相关脏器损伤的发生及临床结局,为临床诊治提供参考。

Objective To explore the clinical value of urine semi-quantitative colorimetry by sodium dithionite reduction method in the diagnosis and treatment of diquat poisoning.Methods The data of 49 patients with acute diquat poisoning treated in the First Affiliated Hospital of Nanjing Medical University from December 3,2020 to November 23,2022 were retrospectively analyzed,the correlation between urine colorimetric results and plasma diquat concentration was observed,and the predictive value of urine colorimetric results for target organ damage and prognosis were evaluated.Results There was a significant correlation between urine colorimetric results and plasma diquat concentration,the correlation coefficient was r=0.89,P<0.01.The cut-off value of urine colorimetry for the predicting the damage of gastrointestinal tract,liver,kidney,and central nervous system injury were 2.5,3.5,3.5,5.5,respectively;in which the urine colorimetric results showed the highest sensitivity in predicting digestive tract injury[AUC 0.93(95%CI:0.89-1.00)].The cut-off value of urine colorimetry for the prognosis of death was 4.5,the positive predictive value was 64.2%,and the negative predictive value was 95.2%.Conclusions The urine semi-quantitative method can be used for rapid prediction of the plasma diquat concentration range on admission.The urine colorimetry results can also effectively predict the occurrence of organ injury and clinical outcome related to diquat poisoning,which provides evidence for the clinical diagnosis and therapy.