摘要
目的分析百草枯中毒患者早期血白细胞计数(WBC)和动脉血乳酸(Lac)水平与近期生存间的关系,探讨其对预后评估的价值.方法回顾性分析2015年1月至2018年5月就诊于东部战区总医院急救医学科的急性百草枯中毒患者的临床资料,以中毒后28 d是否死亡为标准将研究对象分为死亡组和存活组.分析两组患者的血WBC、动脉Lac以及其他临床实验室检查和相关资料,并运用Logistic回归、受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)等方法研究血WBC、动脉血Lac及两指标联合在百草枯中毒患者预后评估中的价值.结果在符合纳入排除标准的62名急性百草枯中毒患者中,存活组27例,死亡组35例,病死率为56%.死亡组血WBC(20.20×10^9/L vs.9.00×10^9/L)、动脉血Lac(7.50 mmol/Lvs.0.90 mmol/L)明显高于存活组(P<0.05).同时,多因素Logistic回归分析结果提示,血WBC[回归系数=0.193,OR=1.213,95%CI(1.021~1.441),P<0.05]、动脉血Lac[回归系数=0.492,OR=1.635,95%CI(1.102,2.428),P<0.05]是百草枯中毒患者死亡事件的独立危险因素.ROC曲线分析结果提示,血WBC的曲线下面积(area under curve,AUC)为0.874(95%CI0.788~0.959),最大Youden指数为0.607,最佳截断值为12.1×10^9/L;动脉Lac的AUC为0.898(95%CI 0.824~0.972),最大Youden指数为0.644,最佳截断值为2.1mmol/L;两指标联合时AUC为0.922(95%CI0.851~0.993),以AUC>0.8为标准,上述参数均是百草枯中毒患者预后评估的有效指标.结论早期血WBC、动脉血Lac是急性百草枯中毒预后相关的独立危险因素,联合二者预测急性百草枯中毒患者生存的价值较高,有望用于临床百草枯中毒患者的病情监测及预后评估.
objective To analyze the relationship between early white blood cell count(WBC) f arterial blood lactate(Lac)and recent survival of patients with paraquat poisoning,estimating their wognostic value in these patients.Methods The clinical data of patients with acute paraquat poisoning mo were admitted to Department of Emergency Medicine.Jinling Hospital.from Jan 2015 to May 2018 ,ere retrospectively analyzed.Patients were divided into death or survival group based on their living tatus of the 28th days after poisoning.The WB0(20.20×10^9/L vs.9.00×10^9/L),Lac(7.50 mmol/vs.0.90 mmol/L),other clinical laboratory indicators and related data were statistically analyzed in the two groups.Longistic regression and ROC curves were used to evaluate the predictive value of WBC,Lac and the combination of the two indicators in the prognosis of patients with paraquat poisoning.Results Sixty-two patients with acute paraquat poisoning were enrolled,27 survived,35 died,and the mortality rate was 56%.The WBC and Lac in the death group were significantly higher than the survival group (P<0.05).Moreover,multivariate Longistic regression showed WBC [regression coefficient=0.193, OR=1.213,95%CI(1.021-1.441),P<0.05],Lac[ regression coefficient=0.492,OR=1.635, 95%CI(1.102-2.428),P<0.05] are independent risk factors in patients with paraqnat poisoning. The area trader(AUC)the ROC CllFVe of white blood cell count was 0.874(95% CI0.788-0.959), the maximum Youden index was 0.607.and the optimal cut-off value was 12.1×10^9/L AUC of arterial blood lactate was 0.898(95% CI0.824-0.972),the maximum Youden index was 0.644,and the optimal cut-off value was 2.1 mmol/L;the area under the ROC curve of combining the two indicators is 0.922(95% CI0.851-0.993).With AUC>0.8 as the standard,the above parameters are effective indicators for evalnating the prognosis of death in patients with paraquat poisoning. Conclusion Early WBC and Lac are independent risk factors associated with prognosis in patients with acute paraquat poisoning.The combination of the two parameters predicts the prognosis of patients with acute paraquat poisoning well,which is expected to be used for clinical monitoring and prognosis evaluation of patients with paraquat poisoning.
作者
葛鑫
符红娜
陈鑫
孙兆瑞
白小翠
杨志洲
聂时南
Ge Xin;Fu Hong-na;Chen Xin;Sun Zhao-rui;Bai Xiao-cui;Yang Zhi-zhou;Nie Shi-nan(Department of Emergency Medicine, General Hospital of Eastern Theater Command, PLA, Nanjing 210002, China)
出处
《中国急救医学》
CAS
CSCD
北大核心
2019年第8期731-735,共5页
Chinese Journal of Critical Care Medicine
基金
国家自然科学基金青年基金课题(81701894)
全军后勤面上项目(CNJl4L002)
江苏省社会发展面上项目(BE2017720).
关键词
百草枯
中毒
预后
白细胞计数(WBC)
乳酸(Lac)
Paraquating
Poisoning
Prognosis
White blood cell count(WBC)
Arterial blood lactatd (Lac)
