Paradoxical systemic toxicity by inhaled paraquat poisoning: A case report

Rationale:Multi-organ failure is a symptom of paraquat poisoning,resulting in high mortality and morbidity rates.Though paraquat is widely available,poisoning through inhalation is rare.Patient’s Concern:A 37-year-old male reported to the emergency department with complaints of vomiting after an alleged history of inhalation of paraquat while at work.Diagnosis:Paraquat poisoning.Interventions:Supportive management along with multiple sessions of hemodialysis.Outcomes:Renal complications caused by paraquat were improved after multiple sessions of hemodialysis.However,the patient developed respiratory complications and later due to persistent hypoxemia and non-responsive to supportive therapy,he succumbed to his illness.Lessons:Acute kidney injury is a complication of paraquat poisoning.However,kidney involvement with the inhalational mode is rare.It is caused by reduction and oxidation cycles,as well as the formation of reactive oxygen species,necessitating hemodialysis as the treatment.Without a clear history,a specific clinical trait,or a diagnostic test,diagnosis can be difficult.Our case thus highlights the inhaled paraquat poisoning,presenting with acute kidney injury with late respiratory impairment as a consequence.

Acute lung injury mechanism and therapy induced by paraquat poisoning

Paraquat (PQ, methyl viologen) was widely used in agricultural production throughout the world in 1962 for its efficient herbicidal activity. PQ was also highly toxic drug. About 5 mL medicine including 20% paraquat was life-threatening that can cause poisoning. In 1966, some people died because of PQ poisoning. Most patients had acute respiratory distress syndrome after 2 wk, and 70% of them died due to the lack of effective detoxification drugs. Thus, it was particularly important to understand the pathogenesis of PQ poisoning and give some effective treatments. This article will review the toxicological mechanism and treatment on PQ poisoning of acute lung injury.

Risk factors and optimal predictive scoring system of mortality for children with acute paraquat poisoning

BACKGROUND There is no suitable scoring system that can be used to predict mortality in children with acute paraquat intoxication(APP).AIM To optimize a predictive scoring system for mortality in children with APP.METHODS A total of 113 children with APP from January 1,2010 to January 1,2020 were enrolled in this study.These patients were divided into survivors and nonsurvivors.We compared the clinical characteristics between the two groups and analyzed the independent prognostic risk factors.The survival rates of patients with different values of the pediatric critical illness score(PCIS)were assessed using kaplan-meier survival analysis.The best scoring system was established by using the area under the receiver operating characteristic curve analysis.RESULTS The overall mortality rate was 23.4%.All non-survivors died within 20 days;48.1%(13/27)died within 3 days,and 70.3%(19/27)died within 7 days.Compared to survivors,the non-survivors were older,had higher white blood cell count,alanine aminotransferase(ALT),aspartate aminotransferase,serum creatinine,blood urea nitrogen,glucose,and pediatric early warning score,and had lower platelet count,albumin,Serum sodium(Na+)and PCIS.ALT and PCIS were the independent prognostic risk factors for children with APP.The survival rate of children classified as extremely critical patients(100%)was lower than that of children classified as critical(60%)or noncritical(6.7%)patients.The specificity of ALT was high(96.51%),but the sensitivity was low(59.26%).The sensitivity and specificity of ALT combined with PCIS were high,92.59%and 87.21%,respectively.The difference in mortality was significantly higher for ALT combined with PCIS(area under the receiver operating characteristic:0.937;95%CI:0.875-0.974;P<0.05).CONCLUSION In our study,ALT and PCIS were independent prognostic risk factors for children with APP.ALT combined with PCIS is an optimal predictive mortality scoring system for children with APP.

Effects of hemoperfusion combined with hemodialysis on target organ damage in patients with acute paraquat poisoning

Objective: To investigate the effects of hemoperfusion combined with hemodialysis on target organ damage in patients with acute paraquat poisoning. Methods: A total of 42 patients with acute paraquat poisoning who were admitted and treated in our hospital between December 2013 and October 2017 were selected as the research subjects, and their therapies were reviewed and used to divide them into the control group (n=20) who received hemoperfusion alone and the combined treatment group (n=22) who received hemoperfusion combined with hemodialysis. The differences in the levels of liver and kidney function indexes in peripheral blood as well as lung function indexes in arterial blood were compared between the two groups of patients immediately after admission, after 1 d of treatment and after 3 d of treatment. Results: Immediately after admission, the differences in the levels of liver and kidney function indexes in peripheral blood as well as lung function indexes in arterial blood were not statistically significant between the two groups. After 1d of treatment and after 3 d of treatment, kidney function indexes Scr, BUN and β2-MG levels in peripheral blood of combined treatment group were lower than those of control group at corresponding time points respectively;liver function indexes ALT, AST, TB and ALP levels in peripheral blood were lower than those of control group at corresponding time points respectively;lung function indexes PaO2, BE and PCO3- levels in arterial blood were higher than those of control group at corresponding time points respectively whereas PaCO2 levels were lower than those of control group at corresponding time points respectively. Conclusion: Compared with hemoperfusion alone, hemoperfusion combined with hemodialysis is more advantageous in protecting the functions of liver, kidney, lungs and other target organs of patients with acute paraquat poisoning.

Evaluation of gastric lavage efficiency and utility using a rapid quantitative method in a swine paraquat poisoning model

BACKGROUND:Gastric lavage(GL)is one of the most critical early therapies for acute paraquat(PQ)poisoning;however,details of the treatment protocol remain to be established.METHODS:A rapid quantitative method involving sodium dithionite testing was developed.It was validated for the determination of the PQ concentrations in gastric juice and eluate samples from a swine acute PQ poisoning model with early or delay GL,or without.The vital signs,laboratory testing,and PQ plasma concentrations were collected for therapeutic effect evaluation.RESULTS:The reaction conditions of the test were optimized for two types of samples.Early GL at one hour(H1)could improve the signs and symptoms after acute PQ poisoning at 24 hours(H24).In contrast,GL at 6 hours(H6)could only partially relieve the vital signs.The H1 GL group effectively reduced the peak of the plasma PQ concentration.In addition,the PQ concentrations in the plasma and the gastric juice were significantly decreased in both the GL groups as compared to the untreated group at H24.Moreover,there was no significant difference in the washing efficiencies calculated from the total eluates between the two GL groups.However,the washing efficiency of the first 10 L eluate is superior to that of the additional 10 L eluate.CONCLUSION:GL only at early stage may it benefit PQ poisoning in an animal model.The currently used 20 L GL volume may need to be reduced in view of the low washing efficiency in the later 10 L eluate.The rapid quantitative method can be used for gastric juice sample and has a certain value for clinical GL practices.

Expression of heat shock protein 70 in lung tissuesof acute paraquat poisoned rats and interventionof ulinastatin

BACKGROUND： Paraquat （PQ） is an effective herbicide and is widely used in agricultural production, but PQ poisoning is frequently seen in humans with the lung as the target organ. Clinically pulmonary pathological changes are often used to predict the severity and prognosis of the patients. In this study, we observed the expression of heat shock protein 70 （HSP70） in rat lung after PQ poisoning and to investigate the therapeutic effects of ulinastatin.METHODS： Seventy-two adult healthy SD rats were randomly divided into a control group （group A, n=24）, a poisoning group （group B, n=24）, and an ulinastatin group （group C, n=24）. The rat models of acute PQ poisoning were established by intra-gastric administration of 80 mg/kg PQ to rats of groups B and C, and the rats of group C were intra-peritoneally injected with 100 000 IU/kg ulinastatin 30 minutes after poisoning. The expression of HSP70 in lung tissue was observed, and W/D and histopathological changes in the lung tissue were compared 12, 24, 48 and 72 hours after poisoning. The expression of HSP70 in the lung tissue was assayed by using RT-PCR. All quantitative data were processed with one-way analysis of variance to compare multiple sample means.RESULTS： Compared to group A, the expression of HSP70 in the lung of rats in groups B and C increased signi？ cantly at all intervals （P〈0.05）. The pathological changes in lung tissue of rats with PQ poisoning included congestion, leukocytes in？ ltration and local hemorrhage, whereas those of group C were signi？ cantly lessened.CONCLUSION： Ulinastatin may ameliorate acute lung injury to some extent after PQ poisoning in rats by enhancing the expression of HSP70.

血必净注射液联合乙酰半胱氨酸对急性百草枯中毒肝肾损伤的作用

目的探讨血必净注射液联合乙酰半胱氨酸(acetylcysteine,AC)对急性百草枯中毒(acute paraquat poisoning,APP)肝肾损伤的作用。方法回顾性分析救治的80例APP患者的临床资料,按治疗方式不同分为AC组(n=39,常规治疗联合AC)、联合组(n=41,在AC组治疗的基础上加用血必净注射液)。比较2组治疗前、治疗2周后呼吸指标[动脉血氧分压(PaO_(2))、氧合指数]、炎症因子水平[白细胞介素-6(interleukin-6,IL-6)、转化生长因子β_(1)(transforming growth factor-β_(1),TGF-β_(1))]和肝肾功能指标[丙氨酸氨基转移酶(glutamic pyruvic transaminase,GPT)、天冬氨酸氨基转移酶(glutamic oxaloacetic transaminase,GOT)、血肌酐(serum creatinine,Scr)和肾小球滤过率(estimated glomerular filtration rate,eGFR)],并观察预后。结果治疗后,2组PaO_(2)、氧合指数和eGFR均较治疗前明显升高(P<0.05),且联合组均明显高于AC组(P<0.05);治疗后,2组血清IL-6、TGF-β_(1)水平和GPT、GOT、Scr均较治疗前明显降低(P<0.05),且联合组均明显低于AC组(P<0.05);联合组1个月内脏器功能衰竭发生率(32.56%vs.56.41%)、病死率(60.98%vs.82.05%)均明显低于AC组(P<0.05)。结论血必净注射液联合AC治疗APP,可明显减轻肝肾损伤,有效抑制炎症反应,显著提高患者的存活率。

百草枯中毒患者外周血对氧磷酯酶1、程序性死亡因子-1、γ干扰素诱导蛋白-10水平检测的意义

目的探讨百草枯中毒患者外周血对氧磷酯酶1(PON1)、程序性死亡因子-1(PD-1)、γ干扰素诱导蛋白-10(IP-10)水平对预后的价值。方法对2017年5月—2023年4月中国人民解放军联勤保障部队第九八〇医院120例百草枯中毒患者进行前瞻性研究,统计百草枯中毒患者30 d内死亡与生存情况,比较不同预后患者临床资料及外周血PON1、PD-1、IP-10水平。采用Pearson相关性分析探讨外周血PON1、PD-1、IP-10水平与中毒剂量、序贯器官衰竭估计(SOFA)评分、急性生理与慢性健康评分系统Ⅱ(APACHEⅡ)评分的相关性;采用受试者工作特征(ROC)曲线评价外周血PON1、PD-1、IP-10水平预测百草枯中毒患者预后的价值。结果随访期间共35例患者死亡(29.17%)。死亡患者中毒剂量、SOFA评分、APACHEⅡ评分及外周血IP-10、PD-1水平均高于生存患者,外周血PON1水平低于生存患者,差异有统计学意义(P<0.05)。相关性分析显示,百草枯中毒患者外周血PON1水平与中毒剂量、APACHEⅡ评分及SOFA评分均呈负相关,PD-1、IP-10水平与中毒剂量、APACHEⅡ评分及SOFA评分均呈正相关(P<0.05);PON1、PD-1、IP-10预测百草枯中毒的曲线下面积(AUC)分别为0.738、0.774、0.770,三者联合预测的AUC为0.922,三者联合预测效能高于各指标单独预测。结论百草枯中毒患者外周血PON1、PD-1、IP-10联合检测对判断患者预后具有较高价值。

Acute kidney injury from different poisonous substances

AIM To report our experience of acute kidney injury(AKI) developed after exposure to poisonous substance.METHODS Retrospective study where data was collected from case records of patients coming to this institute during January 1990 to May 2016.This institution is a tertiary care center for renal care in the metropolitan city of Karachi,Pakistan.History of ingested substance,symptoms on presentation,basic laboratory tests on arrival,mode of treatment and outcome were recorded from all patients and are presented here.Patients developing AKI after snake envenomation or scorpion stings are not included in this study.RESULTS During studied period 184 cases of AKI developing after poisoning were seen at our institution.The largest group was from paraphenyline diamine poisoning comprising 135 patients,followed by methanol in 8,organophosphorus compounds in 5,paraquat in 5,copper sulphate in 5,tartaric acid in 4,phenobarbitone in 3 and benzodiazipines,datura,rat killer,fish gall bladder,arsenic,boiler water,ammonium dichromate,acetic acid and herbs with lesser frequency.In 8 patients multiple substances were ingested in combination.Renal replacement therapy was required in 96% of patients.Complete recovery was seen in 72.28% patients,20% died during acute phase of illness.CONCLUSION It is important to report poisonous substances causing vital organ failure to increase awareness among general population as well as health care providers.

Anthrahydroquinone-2,6-disulfonate alleviates paraquat-induced kidney injury via the apelin-APJ pathway in rats

Objective:To explore the protective effects of anthrahydroquinone-2,6-disulfonate(AH_(2)QDS)on the kidneys of paraquat(PQ)poisoned rats via the apelin-APJ pathway.Methods:Male Sprague Dawley rats were divided into four experimental groups:control,PQ,PQ+sivelestat,and PQ+AH_(2)QDS.The PQ+sivelestat group served as the positive control group.The model of poisoning was established via intragastric treatment with a 20%PQ pesticide solution at 200 mg/kg.Two hours after poisoning,the PQ+sivelestat group was treated with sivelestat,while the PQ+AH_(2)QDS group was given AH_(2)QDS.Six rats were selected from each group on the first,third,and seventh days after poisoning and dissected after anesthesia.The PQ content of the kidneys was measured using the sodium disulfite method.Hematoxylin-eosin staining of renal tissues was performed to detect pathological changes.Apelin expression in the renal tissues was detected using immunofluorescence.Western blotting was used to detect the expression levels of the following proteins in the kidney tissues:IL-6,TNF-α,apelin-APJ(the apelin-angiotensin receptor),NF-κB p65,caspase-1,caspase-8,glucose-regulated protein 78(GRP78),and the C/EBP homologous protein(CHOP).In in vitro study,a PQ toxicity model was established using human tubular epithelial cells treated with standard PQ.Twenty-four hours after poisoning,sivelestat and AH_(2)QDS were administered.The levels of oxidative stress in human renal tubular epithelial cells were assessed using a reactive oxygen species fluorescence probe.Results:The PQ content in the kidney tissues of the PQ group was higher than that of the PQ+AH_(2)QDS group.Hematoxylin-eosin staining showed extensive hemorrhage and congestion in the renal parenchyma of the PQ group.Vacuolar degeneration of the renal tubule epithelial cells,deposition of crescent-like red staining material in renal follicles,infiltration by a few inflammatory cells,and a small number of cast formation were also observed.However,these pathological changes were less severe in the PQ+sivelestat group and the PQ+AH_(2)QDS group(P<0.05).On the third day after poisoning,immunofluorescence assay showed that the level of apelin in the renal tissues was significantly higher in the PQ+AH_(2)QDS group than in the PQ group.Western blotting analysis results showed that IL-6,TNF-α,NF-κB p65,caspase-1,caspase-8,GRP78,and CHOP protein levels in the PQ group were higher than in the PQ+AH_(2)QDS group(P<0.05).The expression of apelin-APJ proteins in the PQ+AH_(2)QDS group was higher than in the PQ+sivelestat and PQ groups(P<0.05);this difference was significant on Day 3 and Day 7.The level of oxidative stress in the renal tubular epithelial cells of the PQ+AH_(2)QDS group and the PQ+sivelestat group was significantly lower than in the PQ group(P<0.05).Conclusions:This study confirms that AH_(2)QDS has a protective effect on PQ-poisoned kidneys and its positive effect is superior to that of sivelestat.The mechanism of the protective effects of AH_(2)QDS may be linked to reduction in cellular oxidative stress,PQ content of renal tissue,inflammatory injury,endoplasmic reticulum stress,and apoptosis.AH_(2)QDS may play a role in the treatment of PQ poisoning by upregulating the expression of the apelin-APJ.

基于网络药理学研究黄连治疗百草枯中毒致急性肝损伤的分子机制

目的应用网络药理学方法,探讨黄连在治疗百草枯中毒导致的急性肝损伤时的潜在相关分子机制。方法在中药系统药理学数据库与分析平台(TCMSP)中查询并获得黄连活性成分和靶点。通过人类基因数据库GeneCards获取百草枯中毒导致的急性肝损伤的相关靶点基因。采用Cytoscape 3.7软件制作药物-成分-疾病靶点的网络框架图。利用STRING数据库获得交集靶点的蛋白质-蛋白质相互作用网络图。利用DAVID数据库对基因功能和通路富集进行分析。综合考虑靶点和通路富集情况,选取AKT1和p-AKT1进行动物实验验证。结果共收集黄连活性成分14个,相关作用靶点基因278个,其中与百草枯中毒导致的急性肝损伤的交集靶点基因32个。排名前6位的靶点蛋白是AKT1、TOP1、ErbB2、TLR4、PTGS2、MPO。同时富集到有关的信号通路包括催乳素信号通路、胰腺癌、表皮生长因子受体酪氨酸激酶抑制剂耐药性、FcεRI、膀胱癌、癌症中的中心碳代谢、ErbB信号通路、子宫内膜癌、血管内皮生长因子信号通路等。动物实验结果显示,经过黄连治疗后,百草枯中毒小鼠肝脏病理损伤减轻,炎症指标肿瘤坏死因子-α水平降低,转氨酶水平降低,p-AKT1水平降低。结论黄连在治疗百草枯中毒导致的急性肝损伤中具有多成分、多靶点、多通路的特点。黄连可降低AKT1蛋白的磷酸化水平,从而对百草枯导致的急性肝损伤发挥治疗作用。

急性百草枯中毒患者预后影响因素分析

目的探索简便、高效辨别急性百草枯中毒患者预后的主要影响因素。方法采用回顾性研究方法,选取2010年1月至2019年12月在广州市第十二人民医院住院治疗的201例急性百草枯中毒患者为研究对象,依据出院时病情及中毒后60 d的随访结果,分为存活组(78例)和死亡组(123例)。比较两组患者基本信息、诊疗方案、入院时实验室检验指标的差异,采用二分类logistic回归分析筛选出可独立预测中毒结局的主要影响因素,受试者工作特征曲线(ROC)判定主要影响因素辨别急性百草枯中毒患者预后的效能。采用t检验、χ^(2)检验。结果存活组男33例、女45例,年龄(30.41±14.04)岁;死亡组男61例、女62例,年龄(31.86±14.15)岁。存活组患者百草枯摄入量[(20.95±23.14)ml]、出现呕吐症状比例[70.51%(55/78)]、白细胞计数(WBC)[(12.39±4.93)×10^(9)/L]、血红蛋白(Hb)[(136.56±18.04)g/L]、凝血酶原时间(PT)[(12.49±3.52)s]、谷丙转氨酶(ALT)[(18.30±10.76)U/L]、谷草转氨酶(AST)[(23.44±11.85)U/L]、血糖[(7.09±2.21)mmol/L]、尿素[(4.96±3.48)mmol/L]、肌酐[(98.03±79.33)μmol/L]、肌酸激酶(CK)[(187.78±178.06)U/L]、肌酸激酶同工酶(CKMB)[(18.88±15.50)U/L]、乳酸脱氢酶(LDH)[(190.92±60.50)U/L]及尿蛋白秩次(60.65)均低于死亡组[(62.07±50.59)ml、83.74%(103/123)、(23.15±12.05)×10^(9)/L、(142.32±20.64)g/L、(13.50±3.13)s、(94.04±144.42)U/L、(130.94±184.19)U/L、(8.43±3.49)mmol/L、(9.55±8.17)mmol/L、(249.98±196.40)μmol/L、(336.36±261.96)U/L、(43.91±43.74)U/L、(346.01±196.50)U/L、126.59],差异均有统计学意义(均P<0.05)。存活组患者动脉血二氧化碳分压(PaCO_(2))[(4.33±0.58)kPa]、血碳酸氢根浓度(HCO_(3)^(-))[(21.12±2.36)mmol/L]均高于死亡组[(3.81±1.25)kPa、(16.85±4.75)mmol/L],差异均有统计学意义(均P<0.05)。二分类logistic回归分析显示,百草枯摄入量(OR=1.022,P<0.05)、HCO_(3)^(-)(OR=0.763,P<0.05)、AST(OR=1.059,P<0.05)、血糖(OR=1.235,P<0.05)、尿蛋白(OR=1.878,P<0.05)是影响急性百草枯中毒患者预后的关键因素。进一步ROC分析显示,5个指标在预测急性百草枯中毒患者预后中均具有较高效能,其中预测价值最高的指标为AST[曲线下面积(AUC)为0.87,最佳诊断值为35.30 U/L],灵敏度最高的指标为尿蛋白(灵敏度0.94),特异度最高的指标为HCO_(3)^(-)和AST(特异度均为0.96);阳性预测值最高的指标为HCO_(3)^(-)和AST(阳性预测值均为0.96),阴性预测值最高的指标为尿蛋白(阴性预测值为0.86)。结论百草枯摄入量、HCO_(3)^(-)、AST、血糖、尿蛋白是预测急性百草枯中毒结局的主要影响因素,具有较高的预测效能和灵敏度、特异度,可用于独立辨别急性百草枯中毒患者预后。

早期肾损伤指标检测对急性百草枯中毒患者预后的预测价值分析

目的 探讨早期肾损伤指标检测对急性百草枯中毒(APP)患者预后的预测价值。方法 回顾性分析2019年6月—2021年6月广州市第十二人民医院收治的90例APP患者的临床资料,根据患者预后情况将经治疗后死亡的APP患者纳入死亡组(52例),存活的APP患者纳入存活组(38例);对比两组患者入院时与入院后3 d的胱抑素C(Cys-C)、血清肌酐(Scr)、视黄醇结合蛋白(RBP)、血乳酸(Lac)、β2微球蛋白(β2-MG)水平,分析患者入院时的β2-MG、Cys-C、RBP、Scr水平与APACHEⅡ评分、服毒量、Lac间的相关性。结果 入院时与入院后3 d死亡组患者的β2-MG、Cys-C、RBP、Scr、Lac水平均高于存活组(P<0.05);相关分析结果显示,早期APP患者的APACHEⅡ评分与β2-MG水平无显著相关性(r=0.143,P>0.05),与Cys-C、RBP、Scr水平呈正相关(r=0.282、0.386、0.179,P<0.05);早期APP患者的Lac水平与β2-MG、Cys-C、RBP、Scr水平呈正相关(r=0.158、0.179、0.288、0.199,P<0.05);早期APP患者的β2-MG、Cys-C、RBP、Scr水平与患者服毒量呈正相关(r=0.177、0.256、0.373、0.202,P<0.05)。结论β2-MG、Cys-C、RBP、Scr指标检测对APP患者病情及预后的预测价值较高,APP患者病情危重程度与β2-MG、Cys-C、RBP、Scr等指标表达水平均呈正相关。

急诊血液灌注治疗百草枯急性中毒的临床效果

目的:分析急诊血液灌注治疗百草枯急性中毒的临床效果。方法:选取2018年3月—2022年3月滨州医学院附属医院收治的百草枯急性中毒患者62例作为观察对象,2018年3月—2020年11月进行常规治疗的患者31例为对照组,2020年12月—2022年3月进行血液灌注治疗的患者31例为观察组。比较两组患者治疗效果。结果:观察组急救成功率高于对照组,差异有统计学意义(P=0.036);治疗3周后,观察组肝功能障碍、肾功能障碍、中毒性心肌炎、多器官功能障碍综合征发生率低于对照组,死亡病例平均存活时间长于对照组,死亡率低于对照组,差异有统计学意义(P<0.05)。结论:百草枯急性中毒患者在急救过程中使用血液灌注治疗,能有效提高抢救成功率,提高治疗效果。

急救流程再造对急性百草枯中毒患者抢救效率及满意度影响的研究

目的 探讨急救流程再造对急性百草枯中毒患者抢救效率及满意度的影响。方法 选取2018年8月—2020年8月南京医科大学第一附属医院急诊接诊的60例急性百草枯患者作为研究对象。按照随机数字表法,将其分为对照组和研究组,每组30例患者。对照组按照急诊常规中毒急救流程进行救治,研究组运用急救流程再造进行急救干预。比较两组患者急诊救治的相关指标(分诊时间、接诊时间、洗胃时间、血液灌流时间)及就诊满意度,患者出院时结局。结果 两组患者一般资料具有可比性;研究组的分诊时间、接诊时间、洗胃时间、血液灌流时间均短于对照组,研究组患者的就诊满意度高于对照组,差异有统计学意义(P<0.05);研究组出院时的患者存活率高于对照组,病死率低于对照组,但两组间差异无统计学意义(P>0.05)。结论 急救流程再造可有效缩短急性百草枯中毒患者的急诊救治时间,提高患者的抢救效率和就诊满意度,值得临床借鉴。

急性百草枯中毒患者并发肝损伤预测模型的构建与评估

目的构建和评估急性百草枯中毒(APP)患者并发肝损伤的预测模型。方法回顾性分析2010年9月至2022年1月期间就诊于四川大学华西医院急诊科的APP患者,收集患者人口学特征及血清学指标结果,根据住院期间最差的肝功能指标分为肝损伤组和非肝损伤组,采用随机森林进行APP患者并发肝损伤的变量优化,应用多因素Logistic回归分析确定APP患者并发肝损伤的独立危险因素并构建列线图模型,使用C指数、校准曲线和决策曲线分析来评估预测模型的区分性、校准度和临床实用性。结果列线图中的预测因素包括年龄、就诊时血清胱抑素C和尿素氮。基于上述指标构建列线图模型,该模型的准确度与区分性较好,C指数为0.902(95%CI 0.867~0.937),校准C指数为0.894。决策曲线分析表明,该列线图模型具有良好的临床应用潜力。结论年龄、就诊时血清胱抑素C和尿素氮是APP患者发生肝损伤的独立危险因素,基于上述3项指标构建的列线图模型具有较好的预测准确性、区分性和临床实用性。

急性百草枯中毒治疗后急性肾损伤的高危因素及预后模型构建

目的探究急性百草枯中毒治疗后发生急性肾损伤(AKI)的高危因素,并建立预后风险的预测模型,从而为急性百草枯中毒治疗后出现AKI的高危因素确定及预后效果的预测提供参考。方法采用回顾性分析方法研究2017年9月—2021年4月因急性百草枯中毒在广州市第十二人民医院住院治疗的患者200例临床资料,依据患者在疗程中是否出现AKI进行分组,对比分析两组患者一般社会学资料、临床指标、疾病史、流行病学资料、影像学检查等临床资料,将其纳入单因素和多因素Logistics回归分析,探究其高危因素。并将多因素Logistics回归分析结果中有统计学意义的指标纳入列线图,建立预后效果的预测预警模型。结果在200例急性百草枯中毒的患者中,出现AKI的患者为154例,发生率为77.00%。在出现AKI的患者中预后良好者为41例,占26.62%,预后不佳者为113例,73.37%。多因素Logistics回归分析结果显示,年龄(OR=3.547,95%CI:2.108~9.723)、百草枯剂量(OR=12.425,95%CI:5.294~19.837)、中毒至入院时间(OR=8.659,95%CI:4.123~12.346)、APACHEⅡ(OR=4.821,95%CI:2.163~9.825)、合并严重疾病(OR=8.518,95%CI:3.327~11.637)、血浆乳酸(OR=2.225,95%CI:1.037~4.338)、合并酸中毒(OR=3.634,95%CI:2.317~10.527)、合并离子紊乱(OR=3.725,95%CI:1.525~8.658)出现AKI预后不佳的可能性更高,血红蛋白(OR=0.753,95%CI:0.418~0.939)则是急性百草枯中毒AKI预后的保护性因素。结论中老年人、合并严重疾病的急性百草枯中毒治疗后急性肾损伤患者预后较差;服药量较高、就医时间较晚是急性百草枯中毒后AKI患者预后不佳的独立危险因素,血红蛋白是AKI患者预后的保护性因素。

中重度百草枯中毒患者的临床特征:系统性回顾分析

目的观察百草枯中毒后各器官功能的临床演变,提高百草枯中毒后的早期识别率及治愈率。方法回顾性分析2011年1月-2015年12月解放军总医院第五医学中心急诊科收治的急性中重度口服百草枯中毒患者的临床资料,观察重要脏器功能指标如氧合指数、血清肌酐、肝功能等的动态变化趋势,统计各脏器损伤率、损伤发生时间、损伤临床分型以及各脏器损伤的临床特点。结果共53例患者纳入本研究,平均口服百草枯量约为40(30,60)mL;平均血液百草枯浓度约为0.5(0.2,1.3)μg/mL。53例患者存活21例,存活率为39.62%。死亡组低氧血症发生时间明显早于存活组。根据患者的血肌酐变化趋势,首次提出百草枯中毒急性肾损伤的4种类型(Ⅰa、Ⅰb、Ⅱa、Ⅱb),发现Ⅱb型肾损伤最为严重,同时,死亡组患者的肝、肾功能指标明显高于存活组。结论百草枯中毒可引起多种多样的临床表现,且病情越重,并发症出现越早且越多。笔者首次从临床多角度综合描述了中重度百草枯中毒患者的临床表现及其特征,而且首次根据患者的血肌酐变化趋势对百草枯诱导的肾损伤进行分型及分类,为今后病情判断提供了一个新思路。

百草枯中毒大鼠的GO及KEGG分析

目的探讨百草枯中毒后机体蛋白质表达变化及受影响的信号通路。方法采用同位素标记相对和绝对定量技术检测百草枯中毒大鼠肺组织中差异表达蛋白,对差异表达蛋白进行基因本体论(gene ontology,GO)功能富集分析和京都基因与基因组百科全书(Kyoto Encyclopedia of Genes and Genomes,KEGG)分析。结果百草枯中毒大鼠肺组织中发现84种差异蛋白,其中48种上调,36种下调。在百草枯中毒早期,差异蛋白主要存在于细胞外区域,主要涉及代谢和应激,补体和凝血级联通路、2-氧代羧酸代谢途径、神经活性配体-受体相互作用途径和金黄色葡萄球菌感染途径4条信号通路受到明显影响。结论差异蛋白和信号转导通路在百草枯致肺损伤早期即可产生变化,可能与炎症损伤和肺纤维化有关。

急性百草枯中毒后早期并发症的特点及其与预后的相关性分析

目的分析急性百草枯中毒患者早期并发症的特点并研究哪些并发症可影响中毒患者的预后。方法对南京军区南京总医院急救医学科2005-01～2011—12收治的87例百草枯急性中毒患者的资料进行回顾分析，在患者服毒一周内采集其病历资料，分析患者出现的各种并发症，并通过四格表∥检验分析中毒死亡组患者与中毒存活组患者之间并发症发生率的统计学差别。结果急性百草枯中毒患者早期的并发症发生率最多的依次为凝血功能障碍、呼吸系统功能损害、胰腺功能损害、肾功能损害、肝功能损害、肌肉损害以及胃肠道出血。而其中肝功能损害、凝血功能障碍、呼吸功能损害、胰腺功能损害、肌肉损害这5项并发症在中毒死亡组患者和中毒存活组患者比较差异有统计学意义（P〈0．05）。结论临床医师应对急性百草枯中毒患者的早期并发症予以关注，预防并治疗服毒患者的肝功能损害、凝血功能障碍、呼吸功能损害、胰腺功能损害、肌肉损害并发症可能对改善患者预后有帮助。