摘要
目的探讨决策曲线分析血清IL-6、淀粉酶(AMS)水平与急诊有机磷农药中毒患者血液灌流治疗预后的关系。方法纳入急诊有机磷农药中毒患者300例,均采用血液灌流治疗。所有患者在治疗前均行血清IL-6、AMS及纤维蛋白原(FIB)水平检测。根据住院期间预后情况将患者分为病死组20例和存活组280例,比较两组患者的临床资料。采用Cox回归模型分析血清IL-6、AMS水平与急诊有机磷农药中毒患者血液灌流治疗预后的关系;采用受试者工作特征(ROC)曲线分析血清IL-6、AMS水平对急诊有机磷农药中毒患者血液灌流治疗预后的预测价值;采用决策曲线分析血清IL-6、AMS联合的预测模型对急诊有机磷农药中毒患者血液灌流治疗预后的预测价值。结果病死组患者血清IL-6、AMS水平均高于存活组,FIB水平低于存活组(P<0.05)。Cox回归模型分析结果显示,血清IL-6、AMS水平升高均为急诊有机磷农药中毒患者血液灌流治疗预后的危险因素,FIB水平升高是其保护因素(P<0.05)。ROC曲线结果显示,血清IL-6、AMS水平预测急诊有机磷农药中毒患者血液灌流治疗预后的ROC曲线下面积(AUC)均>0.7。决策曲线分析结果显示,当高风险阈值为0.05~0.16及0.18~0.32时,血清IL-6、AMS水平联合的预测模型预测急诊有机磷农药中毒患者血液灌流治疗预后的净收益率优于单纯血清IL-6或AMS水平。结论血清IL-6、AMS水平与急诊有机磷农药中毒患者血液灌流治疗预后有关,检测血清IL-6、AMS水平可预测其预后风险,且二者联合预测的净受益率更高。
Objective To explore the relationship between serum interleukin(IL)-6,amylase(AMS)levels with prognosis of hemoperfusion therapy in patients with emergency organophosphorus pesticide poisoning based on decision curve.Methods A total of 300 patients with emergency organophosphorus pesticide poisoning were treated with hemoperfusion.Serum IL-6,AMS and fibrinogen(FIB)levels were detected in all patients before treatment.According to the prognosis during hospitalization,patients were divided into dead group(20 cases)and survival group(280 cases),and clinical data between the two groups were compared.Cox regression model was used to analyze the relationship between serum IL-6,AMS levels with prognosis of hemoperfusion therapy in patients with emergency organophosphorus pesticide poisoning.Predictive value of serum IL-6 and AMS levels on prognosis of hemoperfusion therapy in patients with emergency organophosphorus pesticide poisoning was analyzed by the receiver operating characteristic(ROC)curve.Decision curve was used to analyze the predictive value of combined model of serum IL-6 and AMS in predicting the prognosis of hemoperfusion therapy in patients with emergency organophosphorus pesticide poisoning.Results Serum IL-6 and AMS levels of patients in dead group were higher than those in survival group,while FIB level was lower than that in survival group(P<0.05).Cox regression model analysis showed that elevated serum IL-6 and AMS levels were risk factors for prognosis of hemoperfusion therapy in patients with emergency organophosphorus pesticide poisoning,and elevated FIB level was a protective factor of it(P<0.05).ROC curve results showed that area under ROC curve(AUC)of serum IL-6 and AMS levels predicting prognosis of hemoperfusion therapy in patients with emergency organophosphorus pesticide poisoning were all higher than 0.7.Decision curve analysis results showed that when high risk threshold was 0.05~0.16 and 0.18~0.32,net profit rate of combined prediction model of serum IL-6 and AMS levels in predicting prognosis of hemoperfusion therapy in patients with emergency organophosphorus pesticide poisoning was superior to simple serum IL-6 or AMS level.Conclusion Serum IL-6 and AMS levels are related with prognosis of hemoperfusion therapy in patients with emergency organophosphorus pesticide poisoning.Detection of serum IL-6 and AMS levels can predict risk of prognosis,and prediction of combination with two indexes has a higher net benefit rate.
作者
石娟
陈大贵
齐雪静
Shi Juan;Chen Dagui;Qi Xuejing(Department of Emergency Medicine,Zaoyang First People’s Hospital,Xiangyang 441299,China)
出处
《临床内科杂志》
CAS
2022年第12期818-821,共4页
Journal of Clinical Internal Medicine
