急性有机磷农药中毒继发心肌损伤的危险因素及血清Furin、sTWEAK对其的预测价值分析

Analyze the risk factors of secondary myocardial injury to acute organophosphorus pesticide poisoning and the predictive value of serum Furin and sTWEAK for it

目的探讨急性有机磷农药中毒(AOPP)继发心肌损伤危险因素分析及血清弗林蛋白酶(Furin)、可溶性肿瘤坏死因子样弱凋亡诱导物(sTWEAK)的预测效能。方法选取2021年2月至2023年2月该院收治的146例AOPP患者为研究对象,入院后3 d,根据是否继发中毒性心脏病分别分为无心肌损伤组(84例)和心肌损伤组(62例)。收集所有患者临床资料,采用单因素及多因素Logistic回归分析探讨AOPP患者继发心肌损伤的危险因素,采用酶联免疫吸附试验检测所有患者血清Furin、sTWEAK水平,并采用受试者工作特征(ROC)曲线评估血清Furin、sTWEAK对AOPP患者继发心肌损伤的预测价值。结果146例AOPP患者共有62例发生心肌损伤,发生率为42.47%。单因素分析结果显示,两组性别、服药至入院时间、农药类型比较,差异无统计学意义(P>0.05)。心肌损伤组肌钙蛋白I、肌酸激酶同工酶水平及年龄≥60岁、中毒程度为重度、急性生理学和慢性健康状况评价(APACHE)Ⅱ评分≥20分的比例高于无心肌损伤组(P<0.05)。心肌损伤组血清Furin、sTWEAK水平均高于无心肌损伤组(P<0.05)。血清Furin、sTWEAK预测AOPP患者继发心肌损伤的曲线下面积(AUC)分别为0.813、0.744,二者联合预测的AUC为0.896,高于各指标单独预测。多因素Logistic回归分析显示,中毒程度重度(OR=2.054,95%CI 1.256~3.360),APACHEⅡ评分≥20分(OR=2.323,95%CI 1.334~4.046),血清Furin≥129.48 ng/L(OR=3.380,95%CI 1.689~6.766),血清sTWEAK≥845.86 ng/L(OR=4.988,95%CI 2.057~12.097)均是影响AOPP患者继发心肌损伤的危险因素(P<0.05)。结论AOPP患者继发心肌损伤与其中毒程度及APACHEⅡ评分有关,且血清Furin、sTWEAK水平在AOPP继发心肌损伤患者中升高,对预测AOPP继发心肌损伤患者具有重要临床意义。

Objective To investigate the risk factors of myocardial injury secondary to acute organophosphorus pesticide poisoning(AOPP)and the predictive efficacy of serum Furin and soluble tumor necrosis factor-like weak inducer of apoptosis(sTWEAK).Methods A total of 146 AOPP patients admitted to this hospital from February 2021 to February 2023 were selected as the research objects.Three days after admission,they were divided into non-myocardial injury group(84 cases)and myocardial injury group(62 cases)according to whether they had secondary toxic heart disease.The clinical data of all patients were collected.Univariate and multivariate Logistic regression analysis were used to explore the risk factors of secondary myocardial injury in AOPP patients.The serum Furin and sTWEAK levels of all patients were detected by enzyme-linked immunosorbent assay.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of serum Furin and sTWEAK for secondary myocardial injury in AOPP patients.Results Myocardial injury occurred in 62 of 146 AOPP patients,with an incidence of 42.47%.Univariate analysis showed that there were no statistically significant differences in gender,time from medication to admission,and pesticide type between the two groups(P>0.05).Compared with the non-myocardial injury group,the myocardial injury group had significantly higher levels of tropomin I and creatine kinase isoenzyme and a significantly higher proportion of patients with age≥60 years,severe poisoning,and acute physiology and chronic health evaluation(APACHE)Ⅱscore≥20(P<0.05).The serum levels of Furin and sTWEAK in the myocardial injury group were higher than those in the non-myocardial injury group(P<0.05).The area under curve(AUC)of serum Furin and sTWEAK in predicting secondary myocardial injury in AOPP patients was 0.813 and 0.744,respectively.The AUC of combined prediction of the two was 0.896,which was higher than that of each index alone.Multivariate Logistic regression analysis showed that severe poisoning degree(OR=2.054,95%CI 1.256—3.360),APACHEⅡscore≥20 points(OR=2.323,95%CI 1.334—4.046),serum Furin≥129.48 ng/L(OR=3.380,95%CI 1.689—6.766),serum sTWEAK≥845.86 ng/L(OR=4.988,95%CI 2.057—12.097)were risk factors for secondary myocardial injury in AOPP patients(P<0.05).Conclusion Secondary myocardial injury in AOPP patients is related to the degree of poisoning and APACHEⅡscore,and the serum Furin and sTWEAK levels increase in patients with secondary myocardial injury in AOPP,which have important clinical significance in predicting patients with secondary myocardial injury in AOPP.