敌草快中毒早期危险因素筛选及对预后的预测

Screening of early risk factors and prediction of prognosis in patients with diquat poisoning

目的分析敌草快中毒患者早期血清肌酐等水平的变化特点,筛选早期危险因素并评估其对预后的判断价值。方法选取2020年1月至2022年6月郑州大学第一附属医院收治的敌草快中毒患者进行回顾性分析,收集患者的基本资料及入院第1天(D1)、第3天(D3)和第5天(D5)的血清指标及血气分析。根据中毒后28 d预后分为生存组和死亡组。分析两组之间的临床特征差异,采用多元logistic回归方程筛选变量,并通过绘制受试者工作特征曲线(ROC曲线)评价其对患者预后的预测价值。结果经过筛查共纳入88例患者,其中生存组40例,死亡组48例。死亡组的中毒剂量显著高于生存组[100(40.00,120.00)mL vs.50.00(20.00,90.00)mL,P=0.003]。中毒剂量越多,病死率越高,口服>200 mL者共4例,均死亡。与生存组相比,死亡组患者的丙氨酸转氨酶(alanine aminotransfease,ALT)(D3、D5),肌酐(CR)(D3、D5),血淀粉酶(amylase,AMY)(D5)明显升高,氧分压(PaO_(2))(D5)明显降低(均P<0.05)。多元Logistic回归分析显示CR(D3)、AMY(D5)为中毒后死亡的独立危险因素,PaO_(2)(D5)为独立保护因素。绘制ROC曲线并进行分析,可以得出CR(D3)、AMY(D5)、PaO_(2)(D5)预测敌草快中毒后死亡的ROC曲线下面积分别为0.814、0.741、0.702。其中,CR(D3)预测中毒死亡的ROC曲线下面积最大。结论敌草快中毒患者,口服剂量越大,病死率越高。入院后CR(D3)、AMY(D5)、PaO_(2)(D5)为敌草快中毒预后的独立影响因素,尤其CR(D3)预测中毒后死亡的效能更高,在临床上可作为评估病情严重程度及预后的重要指标。

Objective To analyze the change characteristics of creatinine level in the early stage of patients with diquat(DQ)poisoning,and to explore the early risk factors and the value of prognosis.Methods A retrospective analysis was carried out on patients with DQ admitted to the the first affiliated hospital of Zhengzhou University from January 2020 to June 2022.The DQ patients were divided into death group and the survival group according to the 28 days survival status after posioning.The basic data and serum indexes and blood gas analysis of the patients on day 1(D1),day 3(D3)and day 5(D5)were collected.The difference of clinical features between the two groups was analyzed,the variables were screened by multiple logistic regression analysis,and the predictive value of the variables was evaluated by drawing receiver operating characteristic curve(ROC curve).Results A total of 88 patients were included,including 40 patients in the survival group and 48 patients in the death group.The toxic dose in death group was significantly higher than that in survival group[100(40.00,120.00)mL vs.50.00(20.00,90.00)mL,P=0.003].The higher the toxic dose,the higher the fatality rate.All 4 patients with oral doses greater than 200 mL died.Compared with the survival group,the levels of alanine aminotransferase(ALT)(D3,D5),creatinine(CR)(D3,D5),blood amylase(AMY)(D5)and oxygen partial pressure(PaO_(2))(D5)in the death group were significantly higher than those in the survival group(all P<0.05).Multiple Logistic regression analysis showed that CR(D3)and AMY(D5)were independent risk factors for death after poisoning,and PaO_(2)(D5)was independent protective factor.ROC curve showed that the areas under ROC curve of CR(D3),AMY(D5)and PaO_(2)(D5)were 0.814,0.741 and 0.702,respectively.Conclusion The higher the oral dose,the higher the death rate.After admission,CR(D3),AMY(D5)and PaO_(2)(D5)were independent factors influencing the prognosis of DQ poisoning.In particular,CR(D3)is more effective in predicting death after poisoning.