胆碱酯酶、降钙素原、D-二聚体在急性有机磷中毒患者并发肺部感染中的监测作用

Monitoring effect of cholinesterase,procalcitonin and D-dimer on pulmonary infection in patients with acute organophosphorus poisoning

目的探讨胆碱酯酶(ChE)、降钙素原(PCT)、D-二聚体(D-D)在急性有机磷中毒(AOPP)患者并发肺部感染中的监测作用。方法选取2021年3月至2022年6月该院收治的AOPP患者104例作为研究对象,根据是否并发肺部感染分为感染组(39例)和未感染组(65例)。比较2组患者一般临床资料,分析ChE、PCT、D-D水平与临床其他有差异指标及并发肺部感染的相关性,采用logistic回归模型分析AOPP患者并发肺部感染的危险因素和保护因素,绘制受试者工作特征曲线分析各指标联合检测对AOPP患者并发肺部感染的诊断价值。结果感染组患者有机磷摄入量、白细胞计数(WBC)、急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分,以及PCT、D-D水平均明显高于未感染组,ChE活性明显低于未感染组,差异均有统计学意义(P<0.05)。ChE活性与有机磷摄入量、WBC、APACHEⅡ评分、肺部感染均呈负相关,PCT、D-D水平与之均呈正相关,差异均有统计学意义(P<0.05)。有机磷摄入量、WBC、APACHEⅡ评分,以及PCT、D-D水平均为AOPP患者并发肺部感染的危险因素,ChE活性为其保护因素,差异均有统计学意义(P<0.05)。ChE、PCT、D-D联合检测诊断AOPP患者并发肺部感染的受试者工作特征曲线下面积为0.803。结论AOPP并发肺部感染患者血清ChE表达下调,PCT、D-D表达上调,其联合检测对AOPP患者并发肺部感染具有诊断价值,可作为诊断AOPP患者并发肺部感染的有效指标。

Objective To investigate the role of cholinesterase(ChE),procalcitonin(PCT)and D-dimer(D-D)in monitoring pulmonary infection in patients with acute organophosphorus poisoning(AOPP).Methods 104 cases of AOPP patients admitted to our hospital from March 2021 to June 2022 were selected as the study objects,and were divided into the infected group(39 cases)and the uninfected group(65 cases)according to whether they had pulmonary infection.The general clinical data of the two groups were compared,and the correlation between ChE,PCT,D-D levels and other clinical differential indicators and pulmonary infection was analyzed.The risk factors and protective factors of pulmonary infection in AOPP patients were analyzed by logistic regression model.The receiver operating characteristic curve was drawn to analyze the diagnostic value of combined detection of each index in AOPP patients complicated with pulmonary infection.Results Organophosphorus intake,white blood cell count(WBC),acute physiology and chronic health status evaluationⅡ(APACHEⅡ)scores,PCT and D-D levels in the infected group were significantly higher than those in the non-infected group,and ChE activity was significantly lower than that in the non-infected group,with statistical significance(P<0.05).ChE activity was negatively correlated with organophosphorus intake,WBC,APACHEⅡscore and pulmonary infection,while PCT and D-D levels were positively correlated,with statistical significance(P<0.05).Organophosphorus intake,WBC,APACHEⅡscores,and PCT and D-D levels were all risk factors for pulmonary infection in AOPP patients,and ChE activity was the protective factor,with statistical significance(P<0.05).The area under the curve of AOPP patients complicated with pulmonary infection detected by the combination of ChE,PCT and D-D was 0.803.Conclusion In patients with AOPP complicated with pulmonary infection,the expression of ChE in serum is down-regulated,while the expression of PCT and D-D is up-regulated.The combined detection in patients with AOPP complicated with pulmonary infection has diagnostic value,and can be used as an effective indicator for the diagnosis of pulmonary infection in patients with AOPP.