军事训练所致中暑患者的实验室结果分析

Analysis of Laboratory Indexes of Patients with Heat Stroke Due to Military Training

目的探讨中暑官兵实验室检测指标与病情严重程度的关系。方法回顾性分析2018~2020年(每年6~10月)收治的54例中暑官兵(中暑组)的血常规、凝血功能、生化和免疫学指标,选取部队健康体检官兵70例为对照组。根据中暑的严重程度和临床体征将中暑官兵分为轻度中暑、中度中暑和重度中暑;比较中暑官兵和健康体检官兵以及轻度中暑、中度中暑和重度中暑官兵各项指标的差异;采用Spearman相关分析探讨各指标与病情严重程度的关系。结果中暑组官兵白细胞计数(white blood cell,WBC)、中性粒细胞计数(neutrophil,NEU)、凝血功能5项[除纤维蛋白原(fibrinogen,FIB)外]、尿素氮(urea nitrogen,UREA)、肌酐(creatinine,Cr)、尿酸(uric acid,UA)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、谷氨酰转移酶(glutamine transaminase,GGT)、乳酸脱氢酶(lactic dehydrogenase,LDH)、肌酸激酶(creatine kinase,CK)、肌酸激酶同工酶MB(creatine kinase isoenzyme MB,CK-MB)、肌红蛋白、超敏肌钙蛋白I(hypersensitive cardiac troponin I,hs-cTnI)、白细胞介素2(interleukin 2,IL-2)、IL-6、IL-8和肿瘤坏死因子α(tumor necrosis factor alpha,TNF-α)水平显著高于对照组,C反应蛋白(C-reactive protein,CRP)、FIB水平明显降低,组间比较差异有统计学意义(P均<0.05);轻度中暑、中度中暑和重度中暑患者间的WBC、凝血功能5项[除凝血酶时间(thrombin time,TT)外]、AST、ALT、GGT、LDH、CK-MB、肌红蛋白、hs-cTnI、IL-2、IL-6、IL-8、CK和TNF-α差异有统计学意义(P均<0.05);Spearman相关分析显示,WBC、凝血酶原时间(prothrombin time,PT)、D-二聚体(D-dimer,D-D)、AST、GGT、LDH、CK-MB、肌红蛋白、hs-cTnI、IL-2、IL-6、IL-8、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、ALT、CK和TNF-α与中暑的严重程度呈正相关(r分别为0.377、0.433、0.383、0.497、0.287、0.319、0.348、0.426、0.347、0.435、0.420、0.409、0.469、0.381、0.357、0.391,P均<0.05),FIB与中暑的严重程度呈负相关(r=-0.556,P<0.05)。结论中暑官兵的血常规、凝血功能、生化、免疫学实验室检测指标与中暑程度存在一定的相关性,可为临床诊治提供参考依据。

Objective To evaluate the correlation between the degree of disease and laboratory indexes of officers and soldiers with heat stroke.Methods The routine blood test,coagulation function,biochemical and immunological indexes of 54 officers and soldiers with heat stroke(heat stroke group)admitted to author′s hospital from June 2018 to September 2020 were retrospectively analyzed,70 officers and soldiers who underwent physical examination were enrolled as the control group.According to the severity and clinical signs of heat stroke,the officers and soldiers were divided into mild heat stroke,moderate heat stroke and severe heat stroke;the differences in each index among the officers and soldiers with heat stroke and those who underwent physical examination as well as among officers and soldiers with mild heat stroke,moderate heat stroke and severe heat stroke were compared;the relationship between each index and the severity of the disease was analyzed by Spearman correlation analysis.Results The white blood cell(WBC),neutrophil(NEU),5 items of coagulation function[except for fibrinogen(FIB)],urea nitrogen(UREA),creatinine(Cr),uric acid(UA),aspartate aminotransferase(AST),alanine aminotransferase(ALT),glutamine transaminase(GGT),lactic dehydrogenase(LDH),creatine kinase(CK)creatine kinase isoenzyme MB(CK-MB),myoglobin,hypersensitive cardiac troponin I(hs-cTnI),interleukin 2(IL-2),IL-6,IL-8 and tumor necrosis factor alpha(TNF-α)levels in heat stroke group were significantly higher than control group,the level of C-reactive protein(CRP),FIB significantly decreased,and the difference was statistically significant(all P<0.05);WBC,5 items of coagulation function[except for thrombin time(TT)],AST,ALT,GGT,LDH,CK-MB,myoglobin,hs-cTnI,IL-2,IL-6,IL-8,CK and TNF-αin mild heat stroke,moderate heat stroke and severe heat stroke patients were significantly different(all P<0.05);Spearman correlation analysis showed that:WBC,prothrombin time(PT),D-dimer(D-D),AST,GGT,LDH,CK-MB,myoglobin,hs-cTnI,IL-2,IL-6,IL-8,activated partial thromboplastin time(APTT),ALT,CK and TNF-α were positively correlated with the severity of heat stroke(r were 0.377,0.433,0.383,0.497,0.287,0.319,0.348,0.426,0.347,0.435,0.420,0.409,0.469,0.381,0.357 and 0.391 respectively,all P<0.05),FIB was negatively correlated with the degree of heat stroke(r=-0.556,P<0.05).Conclusion The routine blood cells,coagulation function,biochemistry and immunology in laboratory indexes of the officers and soldiers with heat stroke are correlated with the degree of heat stroke,which can provide reference for clinical diagnosis and treatment.