外周血淀粉酶、NLR、胆碱酯酶水平变化与有机磷农药中毒病情及预后的关系分析

Analysis of the relationship between changes in amylase,NLR,and cholinesterase levels in peripheral blood and the condition and prognosis of organophosphorus pesticide poisoning

目的分析外周血淀粉酶、中性粒细胞-淋巴细胞比值(NLR)、胆碱酯酶水平变化与有机磷农药中毒病情以及预后的关系。方法回顾性选取2019年7月至2020年8月阜阳市人民医院收治的103例有机磷农药中毒患者,根据中毒程度分为轻度组(n=47)、中度组(n=31)和重度组(n=25)。并根据患者出院时的生存情况分为存活组(n=83)和死亡组(n=20)。比较不同预后组患者一般资料[年龄、性别构成比、中毒至就诊时间、有机磷中毒种类、急性生理学和慢性健康状况评价(APACHEⅡ)评分、空腹血糖、动脉血氧分压(PaO_(2))、动脉二氧化碳分压(PaCO_(2))、乳酸、白细胞、血红蛋白、血尿素、血肌酐等]及淀粉酶、NLR、胆碱酯酶水平;采用Logistic回归分析分析影响有机磷农药中毒患者预后不良的因素,并分析各影响因素的预测价值;比较不同病情程度有机磷农药中毒患者的淀粉酶、胆碱酯酶、NLR水平。结果不同预后患者年龄、性别构成比、中毒至就诊时间、有机磷中毒种类、白细胞、血红蛋白、血尿素、血肌酐进行比较,差异均无统计学意义(P>0.05);存活组的APACHEⅡ评分、空腹血糖、PaCO_(2)、乳酸、NLR、淀粉酶水平均低于死亡组,PaO_(2)、胆碱酯酶水平均高于死亡组,差异均有统计学意义(P<0.05)。Logistic回归分析结果显示:APACHEⅡ评分、淀粉酶、NLR、胆碱酯酶是有机磷农药中毒患者预后不良的独立危险因素(P<0.05)。APACHEⅡ评分、淀粉酶、NLR、胆碱酯酶联合预测有机磷农药中毒患者预后不良的受试者工作特征(ROC)曲线下面积是0.934,大于各指标单独预测(0.918、0.864、0.894、0.880)。重度组淀粉酶、NLR水平高于中度组、轻度组,而胆碱酯酶水平低于轻度组、中度组,差异均有统计学意义(P<0.05)。结论有机磷农药中毒严重程度与外周血淀粉酶、NLR、胆碱酯酶水平有关,APACHEⅡ评分、淀粉酶、NLR、胆碱酯酶是有机磷农药中毒预后的影响因素,其联合预测预后的价值较高,值得进一步研究。

Objective To analyze the relationship between peripheral blood amylase,neutrophil-lymphocyte ratio(NLR),cholinesterase levels and organophosphorus pesticide poisoning and prognosis.Methods A total of 103 cases of organophosphorus pesticide poisoning patients admitted to Fuyang People's Hospital from July 2019 to August 2020 were retrospectively selected,and they were divided into mild group(n=47),moderate group(n=31)and severe group(n=25)according to the degree of poisoning.Patients were divided into survival group(n=83)and death group(n=20)based on their survival status at discharge.The general data[age,gender composition ratio,time from poisoning to medical treatment,type of organophosphorus poisoning,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,fasting blood glucose,arterial oxygen partial pressure(PaO_(2)),arterial carbon dioxide partial pressure(PaCO_(2)),lactate,white blood cells,blood red and egg white,blood urea,blood creatinine,etc],and the levels of amylase,NLR,and cholinesterase of patients with different prognosis groups were compared.The factors affecting the poor prognosis of patients with organophosphorus pesticide poisoning were analyzed using logistic regression,and the predictive value of each influencing factor was analyzed.The levels of amylase,cholinesterase,and NLR in patients with different degrees of organophosphorus pesticide poisoning were compared.Results There were no statistically significant differences in age,gender,time from poisoning to admission,proportion of organophosphorus poisoning types,white blood cells,hemoglobin,blood urea,and blood creatinine among patients with different prognosis(P>0.05),the APACHEⅡscore,fasting blood glucose,PaCO_(2),lactate,NLR,and amylase levels in the survival group were lower than those in the death group,while PaO_(2)and cholinesterase levels were higher than those in the death group,the differences were statistically significant(P<0.05).Performed the Logistic regression analysis,the results were:APACHEⅡscore,amylase,NLR,and cholinesterase were independent risk factors for poor prognosis in patients with organophosphorus pesticide poisoning(P<0.05).The combined prediction of APACHEⅡscore,amylase,NLR,and cholinesterase for poor prognosis in patients with organophosphorus pesticide poisoning has a receiver operating characteristic(ROC)curve area of 0.934,which was greater than the(0.918,0.864,0.894,and 0.880)predicted by each indicator alone.The levels of amylase and NLR in the severe group were higher than those in the moderate and mild groups,while the levels of cholinesterase were lower than those in the mild and moderate groups,the differences were statistically significant(P<0.05).Conclusion The severity of organophosphorus pesticide poisoning and peripheral blood amylase,NLR,and cholinesterase levels,APACHEⅡscore,amylase,NLR,and cholinesterase are independent risk factors for poor prognosis of organophosphorus pesticide poisoning,which deserve further study.