摘要
目的分析急性有机磷农药中毒(AOPP)患者血液净化治疗前可溶性致癌抑制因子2(sST2)、血淀粉酶(AMS)水平与病情严重程度及预后的关系。方法选取2020年5月—2023年7月中国人民解放军联勤保障部队第904医院收治的80例AOPP患者,于血液净化治疗前采取日立生化分析仪检测AMS水平;选取全自动生化分析仪检测sST2水平。根据患者病情严重程度分为轻中度组与重度组,比较两组患者sST2、AMS水平,分析AOPP患者病情严重程度与sST2、AMS水平的相关性。统计患者28 d内预后情况,将其分为预后良好组和预后不良组,比较两组患者基础资料,分析影响AOPP患者预后不良的因素及受试者操作特征(ROC)曲线分析AOPP患者预后不良的预测效能。结果80例AOPP患者中,轻度患者36例,中度患者26例,重度患者18例。重度组sST2水平为(44.20±4.32)μg/L、AMS水平为(213.63±32.01)U/L,轻中度组sST2水平为(39.24±3.95)μg/L、AMS水平为(188.52±26.45)U/L。重度组sST2、AMS水平高于轻中度组(t=4.593、3.379,均P<0.05)。Pearman相关性分析显示,AOPP患者病情严重程度与sST2、AMS水平呈正相关(r=5.557,P=0.005;r=5.575,P<0.001)。80例AOPP患者中,死亡患者12例(15.00%)。预后不良组APACHEⅡ评分(22.30±3.52)分、服毒量(112.02±12.52)mL,治疗前sST2水平(48.52±5.21)μg/L、治疗前AMS(246.25±35.14)U/L、中毒程度为重度占比58.33%(7/12),预后良好组APACHEⅡ评分(17.54±2.96)分、服毒量(98.36±8.94)mL,治疗前sST2水平(43.01±4.28)μg/L、治疗前AMS水平(201.06±32.57)U/L、中毒程度为重度占比16.18%(11/68)。预后不良组APACHEⅡ评分、服毒量、治疗前sST2水平、治疗前AMS水平高于预后良好组(t=4.992、4.579、4.574、5.092,均P<0.05);预后不良组中毒程度为重度占比高于预后良好组(χ^(2)=10.401,P=0.006)。经二元Logistic回归分析,APACHEⅡ评分[OR=1.634(95%CI:1.237~2.157)]、服毒量[OR=1.137(95%CI:1.058~1.223)]、治疗前sST2水平[OR=1.387(95%CI:1.131~1.701)]、治疗前AMS水平[OR=1.037(95%CI:1.015~1.060)]、中毒严重程度为重度[OR=7.255(95%CI:1.944,27.067)]是AOPP患者预后不良的影响因素(均P<0.05)。经ROC曲线分析,APACHEⅡ评分、服毒量、治疗前sST2、治疗前AMS水平、中毒严重程度为重度灵敏度分别为0.750、0.667、0.750、0.833、0.583,特异度分别为0.750、0.794、0.691、0.676、0.838。且APACHEⅡ评分、服毒量、治疗前sST2水平、治疗前AMS水平、中毒严重程度为重度联合预测AOPP患者预后不良的价值更高(AUC=0.904)。结论sST2、AMS水平与AOPP患者病情严重程度呈正相关,且sST2、AMS联合检测能够早期预测和改善AOPP患者预后不良。
Objective To analyze the relationship between the levels of soluble suppression tumorigenicity-2(sST2)and blood amylase(AMS)before blood purification treatment and the severity and prognosis of acute organophosphorus pesticide poisoning(AOPP)patients.Methods 80 patients with AOPP admitted to the 904th Hospital of the Joint Logistics Support Force of the People's Liberation Army from May 2020 to July 2023 were selected,and the AMS level was detected by Hitachi biochemical analyzer before blood purification treatment.A fully automatic biochemical analyzer was used to detect sST2 levels.Patients were divided into mild to moderate group and severe group according to the severity of the disease.sST2 and AMS levels of the two groups were compared,and the correlation between the severity of the disease and sST2 and AMS levels of AOPP patients was analyzed.The prognosis of patients within 28 days was analyzed,and they were divided into good prognosis group and poor prognosis group.The basic data of the two groups were compared to analyze the factors affecting the poor prognosis of AOPP patients and the predictive efficacy of receiver operating characteristic(ROC)curve in analyzing the poor prognosis of AOPP patients.Results Among the 80 AOPP patients,36 were mild,26 were moderate and 18 were severe.sST2 and AMS levels were(44.20±4.32)μg/L and(213.63±32.01)U/L in the severe group,(39.24±3.95)μg/L and(188.52±26.45)U/L in the mild to moderate group.The levels of sST2 and AMS in severe group were higher than those in mild to moderate group(t=4.593,3.379,both P<0.05).Pearman correlation analysis showed that the severity of AOPP patients was positively correlated with sST2 and AMS levels(r=5.557,P=0.005;r=5.575,P<0.001).Among the 80 AOPP patients,12 died(15.00%).In the poor prognosis group,APACHEⅡscore(22.30±3.52)score,dose of poison(112.02±12.52)mL,sST2 level before treatment(48.52±5.21)μg/L,AMS before treatment(246.25±35.14)U/L,severity of poisoning accounted for 58.33%(7/12).In the good prognosis group,APACHEⅡscore was(17.54±2.96),dose of poison was(98.36±8.94)mL,the level of sST2 before treatment was(43.01±4.28)μg/L,the level of AMS before treatment was(201.06±32.57)U/L,and the degree of poisoning was severe 16.18%(11/68).APACHEⅡscore,dose of poison,sST2 level before treatment and AMS level before treatment in poor prognosis group were higher than those in good prognosis group(t=4.992,4.579,4.574,5.092,all P<0.05).The pencentage of severity poisoning in the poor prognosis group was higher than that in the good prognosis group(χ^(2)=10.401,P=0.006).Binary Logistic regression analysis showed that APACHEⅡscore[OR=1.634(95%CI:1.237-2.157)],dose of poison[OR=1.137(95%CI:1.058-1.223)],sST2 level before treatment[OR=1.387(95%CI:1.131-1.701)],the level of AMS before treatment[OR=1.037(95%CI:1.015-1.060)]and the severity of poisoning[OR=7.255(95%CI:1.944-27.067)]were the influential factors for poor prognosis of AOPP patients(all P<0.05).According to ROC curve analysis,the sensitivity of APACHEⅡscore,dose of poison,sST2 before treatment,AMS level before treatment and severity of poisoning were 0.750,0.667,0.750,0.833,0.583,respectively.The specificity was 0.750,0.794,0.691,0.676,0.838,respectively.The combination of APACHEⅡscore,dose of poison,sST2 level before treatment,AMS level before treatment,and severity of poisoning was more valuable in predicting poor prognosis of AOPP patients(AUC=0.904).Conclusion:The levels of sST2 and AMS are positively correlated with the severity of AOPP,early combined detection of sST2 and AMS can predict and potentially improve the prognosis of AOPP patients.
作者
邓晓艳
徐海婷
黄爱华
虞大为
DENG Xiaoyan;XU Haiting;HUANG Aihua;YU Dawei(Emergency Department,the 904th Hospital of the Joint Logistics Support Force of the People's Liberation Army,Wuxi Jiangsu 214000,China)
出处
《中国急救复苏与灾害医学杂志》
2025年第7期937-941,共5页
China Journal of Emergency Resuscitation and Disaster Medicine
基金
江苏省自然科学基金面上项目(BK20211054)。
关键词
有机磷农药中毒
血液净化
可溶性致癌抑制因子2
血淀粉酶
病情严重程度
预后
Organophosphorus pesticide poisoning
Blood purification
Soluble suppression tumorigenicity-2
Blood amylase
The severity of the illness
Prognosis
作者简介
通信作者:虞大为,E-mail:18915328533@163.com。
