皮肤损害与重症胡蜂蜇伤患者器官功能损伤的相关性及其预后价值

Correlation and prognostic value between skin damage and organ dysfunction in patients with severe wasp sting

目的 系统描述胡蜂蜇伤皮肤损害的分类及特征,探讨皮肤损害与器官功能损伤的相关性,以及皮肤损害对重症胡蜂蜇伤患者的预后价值。方法 回顾性分析2019年1月1日至2022年12月31日十堰市太和医院急诊科收治的167例胡蜂蜇伤患者的临床资料,包括蜇伤针数、皮肤损伤形态、各项临床检测指标及患者28 d存活情况;统计学分析采用独立样本t检验,Kruskal-Wallis非参数检验和χ^(2)检验;采用单因素分析评估与胡蜂蜇伤病情严重程度的危险因素;采用线性回归进行多因素分析,进而采用岭回归分析以识别影响因子;胡蜂蜇伤皮肤坏死与器官功能指标间行Spearman相关性分析,绘制受试者工作特征曲线(receiver operating characteristic curve, ROC),计算ROC曲线下面积(area under the ROC curve, AUC),以评价相关因素对重症胡蜂蜇伤的预测价值。结果 167例患者中非重症104例(62.3%),皮肤表现以局部红肿、少许出血为主,蜇伤针数<30针,其中<10针53例(51.0%)、10~19针34例(32.7%)、20~29针17例(16.3%),多为单发、轻度器官损害;重症患者63例(37.7%),以皮肤坏死为主要表现,其中蜇伤>90针6例、61~90针6例、30~60针39例、10~29针9例、<10针3例,器官功能损害为多发且持续时间较长,该组患者皮肤坏死发生率、蜇伤针数、序贯器官衰竭评分(SOFA)和死亡率均显著高于非重症组(P<0.05)。岭回归分析结果显示,蜇伤针数、皮肤坏死及SOFA评分对病情分级产生显著的正向影响;Spearman相关性分析显示,皮肤坏死与器官功能损伤程度呈正相关;蜂蜇伤针数对应的AUC值0.954,最佳界值0.870(敏感度0.889,特异度0.981),其蜇伤针数的临界值(cut-off)为25;皮肤坏死对应的AUC值0.799,最佳界值0.598(敏感度0.857,特异度0.740);SOFA评分AUC值0.872,最佳界值0.643(敏感度0.825,特异度0.817)。结论 皮肤坏死及蜇伤针数是早期评估胡蜂蜇伤病情严重程度的简易、有效指标。

Objective Systematically describe the classification and characteristics of skin damage caused by wasp stings,explore the correlation between skin damage and organ function damage,and the prognostic value of skin damage for severe wasp stings patients.Methods The clinical data of 167 patients with wasp sting admitted to the Emergency Department of Taihe Hospital in Shiyan city from January 1,2019 to December 31,2022 were retrospectively analyzed,including the number of stings,injury morphology of skin,various clinical laboratory indices and 28-day survival rate of patients.The statistical analysis was conducted using independent sample t-test,Kruskal-Wallis non-parametric test andχ^(2)test,etc.;the univariate analysis was used to evaluate the risk factors related to the severity of wasp stings.The linear regression was used for multivariate analysis,using ridge regression analysis to identify the influencing factors;Spearman correlation analysis was used to analyze the correlation among number of wasp stings,skin necrosis and organ function indexes;draw the receiver operating characteristic curve(ROC)and calculate the area under the ROC curve(AUC),then,the predictive value of relevant factors for severe wasp sting can be evaluated.Results The results showed that among 167 patients,104 cases(62.3%)were non-severe,the skin manifestations of the patients were mainly local redness,swelling,and slight bleeding,the number of stings by wasps was all less than 30,including 53 cases(51.0%)with less than 10 stings,34 cases(32.7%)with 10~19 stings,and 17 cases(16.3%)with 20~29 stings,the organ damages were single and mild;there were 63 critically ill patients(37.7%)with skin necrosis as the main manifestation,among them,only six cases with more than 90 stings by wasp,another six cases with stings number 61~90,39 cases with the stings number 30~60,nine cases with the stings number 10~29,and three cases with the stings number less than 10,the organ damages were multiple and long lasting,and the incidence of skin necrosis,stings number,sequential organ failure score(SOFA)and mortality rate in severe group were all significantly higher than those of the non-severe group(P<0.05).Additionally,the results of ridge regression analysis showed that the number of stings,skin necrosis and SOFA score had a significant positive effect on the severity of the disease;Spearman correlation analysis showed that skin necrosis was positively correlated with the degree of organ damage;the AUC value corresponding to the number of wasp stings was 0.954 and corresponding to the optimal cut-off value was 0.870(sensitivity was 0.889,specificity was 0.981),and the stings number of cut-off value was 25;the AUC value corresponding to skin necrosis was 0.799 and corresponding to the optimal cut-off value was 0.598(sensitivity was 0.857,specificity was 0.740);the AUC value corresponding to SOFA was 0.872,and the corresponding to the optimal cut-off value was 0.643(sensitivity was 0.825,specificity was 0.817).Conclusion The results suggested that the skin necrosis and the stings number were the simple and effective indicators for early evaluation of the severity of wasp stings.