摘要
目的：探讨血浆百草枯（PQ）浓度定量检测及尿液连二亚硫酸钠定性检测对急性PQ中毒患者预后的早期评估价值。方法采用前瞻性研究方法，纳入2013年8月至2015年12月中国医科大学附属第一医院急诊科收治的急性PQ中毒患者，入院后即刻留取血样及尿样，采用高效液相色谱法测定血浆PQ浓度，采用连二亚硫酸钠测定法进行尿样定性分析；检测相关生化指标，并进行序贯器官衰竭评分（SOFA）。根据随访90d预后将患者分为存活组和死亡组，采用logistic回归分析患者各项指标与预后间的关系，并绘制受试者工作特征曲线（ROC）进行预后评价。结果148例急性PQ中毒患者中存活43例，死亡105例，90d病死率70.9%。死亡组中毒剂量（mL：22.69±18.57比9.91±4.61）、血浆PQ浓度（mg/L：2.28±1.52比0.91±0.38）及尿液连二亚硫酸钠阳性率（87.6%比14.0%）均明显高于存活组（均P＜0.01），而两组性别、年龄、中毒时间、洗胃时间等比较差异无统计学意义。存活组和死亡组患者相关生化指标中仅白细胞计数〔WBC（×10^9/L）：13.45±6.12比23.03±7.67〕和血乳酸〔Lac（mmol/L）：1.50±0.45比8.10±4.51〕存在统计学差异（均P＜0.01），而SOFA评分则差异无统计学意义（分：0.98±0.72比1.34±1.29，P＞0.05）。Logistic回归分析显示，影响PQ中毒患者预后的危险因素依次为尿液连二亚硫酸钠定性〔优势比（OR）＝8.731，95%可信区间（95%CI）＝2.828～26.954， P＝0.000〕、血浆PQ浓度（OR＝2.082，95%CI＝1.204～3.603，P＝0.009）和中毒剂量（OR＝1.175，95%CI＝1.048～1.318，P＝0.006）。ROC曲线分析显示，血浆PQ浓度、尿液连二亚硫酸钠定性、中毒剂量及SOFA评分预测急性PQ中毒患者预后的ROC曲线下面积（AUC）分别为0.866、0.857、0.826、0.631（均P＜0.05）。尿液连二亚硫酸钠定性判断预后的敏感度为87.6%，特异度为83.7%。结论早期血浆PQ浓度可以客观反映机体吸收的毒物剂量及中毒后的实际情况，有助于判断预后。尿液连二亚硫酸钠定性对PQ中毒预后判断也有较高的准确性，且因其简易性和易得性，更易在基层医院开展。
Objective To explore early prognostic value of quantitative detection of paraquat （PQ） plasma concentration and urine sodium dithionite assay for prognosis in patients with acute PQ poisoning. Methods A prospective study was conducted. The patients with acute PQ poisoning admitted to Department of Emergency of First Hospital of China Medical University from August 2013 to December 2015 were enrolled. At admission, blood samples and urine samples were collected. The PQ plasma concentration was determined by high-performance liquid chromatography （HPLC）, and the PQ urine concentration was determined by sodium dithionite, meanwhile the biochemical parameters were determined to carry out sequential organ failure assessment （SOFA） score. According to the prognosis of 90-day follow-up, the patients were divided into survival group and death group. Logistic regression analysis was used to analyze the relationship between the prognosis and the indexes, and the receiver operating characteristic curve （ROC） was drawn to evaluate the prognosis. Results There were 148 patients with acute PQ poisoning, with 43 alive and 105 dead, and the 90-day mortality rate was 70.9%. The ingestion volume （mL： 22.69±18.57 vs. 9.91±4.61）, plasma concentration of PQ （mg/L： 2.28±1.52 vs. 0.91±0.38） and positive rate of urine sodium dithionite （87.6% vs. 14.0%） in death group were significantly higher than those of survived group （all P 〈 0.01）, but no significant differences in gender, age, poisoning time, gastric lavage time between the two groups were found. Significant differences in white blood cell count [WBC （×10^9/L）： 13.45±6.12 vs. 23.03±7.67] and blood lactate [Lac （mmol/L）： 1.50±0.45 vs. 8.10±4.51] between survival group and death group were found （both P 〈 0.01）, while no significant difference in SOFA score was found （0.98±0.72 vs. 1.34±1.29, P 〉 0.05）. It was shown by logistic regression analysis that the key factors affecting the prognosis of patients with PQ poisoning were urine sodium dithionite assay [odds ratio （OR） = 8.731, 95% confidence interval （95%CI） = 2.828-26.954, P = 0.000], PQ plasma concentration （OR = 2.082, 95%CI = 1.204-3.603, P = 0.009） and ingestion volume （OR = 1.175, 95%CI = 1.048-1.318, P = 0.006） respectively. It was shown by ROC curve that the area under ROC curve （AUC） of plasma PQ concentration, urine sodium dithionite assay, poisoning dose and SOFA score for predicting the prognosis in patients with acute PQ poisoning was 0.866, 0.857, 0.826, and 0.631 respectively （all P 〈 0.05）. The sensitivity of urine sodium dithionite assay for predicting the prognosis was 87.6%, and the specificity was 83.7%. Conclusions Early plasma PQ concentrations can objectively reflect the body absorbed toxicant doses and actual situation after poisoning, and help to judge the early evaluation of prognosis. The accuracy of urine sodium dithionite assay in judging the prognosis of PQ poisoning is high. Because of its simplicity and availability, it was easier to be performed in the primary hospital.
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2016年第10期886-890,共5页
Chinese Critical Care Medicine
基金
辽宁省科技计划项目（2013225303）
国家临床重点专科建设项目（2013-544）
关键词
百草枯
中毒
血浆百草枯浓度
连二亚硫酸钠定性
高效液相色谱法
早期评估
Paraquat
Poisoning
Paraquat plasma concentration
Sodium dithionite assay
High-performance liquid chromatography
Early evaluation
作者简介
通讯作者：刘志，Email：pao9999@sina．com
