摘要
目的分析百草枯中毒患者各系统临床损害情况及与免疫球蛋白E(IgE)水平的关系。方法43例口服百草枯中毒患者,根据百草枯口服剂量分为少量组(≤40 mg/kg,16例)和大量组(>40 mg/kg,27例);另选取同期健康体检人员20例作为对照组。患者中毒第3天和对照组研究对象均空腹抽血检查IgE、血常规[白细胞计数(WBC)、中性粒细胞(N)]、肝功能[谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、直接胆红素(DBIL)]、肾功能[尿素氮(UREA)、肌酐(Cr)]、肌酸激酶同工酶(CK-MB)、血淀粉酶(a-AMY),并行心电图、胸部CT检查。比较大量组和少量组中毒早期临床症状发生情况、心电图异常、胸部CT异常及预后(存活/死亡)情况,比较三组实验室指标,分析IgE与其他指标相关性及与肺损伤的关系。结果大量组患者的口腔黏膜损伤、恶心/呕吐、咳嗽、胸闷/胸痛、腹痛/腹泻发生率高于少量组,但差异均无统计学意义(P>0.05)。少量组和大量组WBC、N、UREA、IgE水平均高于对照组,且大量组高于少量组,差异具有统计学意义(P<0.05)。大量组ALT、AST、TBIL、DBIL、CK-MB、a-AMY水平均高于对照组,且ALT水平高于少量组,差异具有统计学意义(P<0.05);少量组与对照组的ALT、AST、TBIL、DBIL、CK-MB、a-AMY水平比较差异无统计学意义(P>0.05)。少量组和大量组男性及女性Cr水平均高于对照组,差异具有统计学意义(P<0.05)。大量组和少量组心电图异常率比较差异无统计学意义(P>0.05)。大量组胸部CT异常率70.37%高于少量组的18.75%,差异具有统计学意义(P<0.05)。随访患者至中毒后2个月,大量组死亡率44.44%(12/27)高于少量组的12.50%(2/16),差异具有统计学意义(P<0.05)。Pearson分析显示:IgE与WBC、N、ALT、AST、TBIL、DBIL、UREA、Cr、CK-MB、a-AMY无相关性(P>0.05)。根据胸部CT结果分为肺正常组(21例)和肺损伤组(22例),肺正常组的IgE(430.43±618.24)mg/L低于肺损伤组的(1001.82±1105.68)mg/L,差异具有统计学意义(t=2.078,P=0.044<0.05)。结论百草枯中毒可致多系统损害,口服少量即可致肾功能损害,可引起人体炎症反应、免疫反应,口服大量者可致肝功能损害、心肌酶损害、高淀粉酶血症,口服大量者肺部损害发生率较高,死亡率较高。IgE水平升高与肺损伤有一定关系。
Objective To analyze the clinical damage of various systems in patients with paraquat poisoning and its correlation with immunoglobulin E(IgE) levels. Methods A total of 43 patients with oral paraquat poisoning were divided into small-dose group(≤40 mg/kg, 16 cases) and large-dose group(>40 mg/kg, 27 cases) according to the oral dose of paraquat;another 20 cases of healthy subjects during the same period were selected as the control group. On the third day of poisoning and the control group, fasting blood samples were drawn to check IgE, blood routine [white blood cell count(WBC), neutrophil(N)], liver function [alanine aminotransferase(ALT), aspartate aminotransferase(AST), total bilirubin(TBIL), direct bilirubin(DBIL)], renal function [urea nitrogen(UREA), creatinine(Cr)], creatine kinase isoenzyme(CK-MB), alpha amylase(α-AMY), as well as electrocardiogram and chest CT examination. Comparison was made on the occurrence of clinical symptoms, electrocardiogram abnormalities, chest CT abnormalities and prognosis(survival/death) in the early stage of poisoning of large-does group and small-dose group. The laboratory indicators of the three groups was compared, so as to analyze the correlation between IgE and other indicators and lung damage. Results The incidence of oral mucosal damage, nausea/vomiting, cough, chest tightness/chest pain, abdominal pain/diarrhea in the large-dose group was higher than that in the small-dose group, but the difference was not statistically significant(P>0.05). The levels of WBC, N, UREA and IgE of small-dose group and large-dose group were higher than those of the control group, and large-dose group was higher than that of small-dose group, and the difference was statistically significant(P<0.05). The levels of ALT, AST, TBIL, DBIL, CK-MB and a-AMY in large-dose group were higher than those of the control group, and ALT was higher than those of small-dose group, and the difference was statistically significant(P<0.05). There was no statistically significant difference in levels of ALT, AST, TBIL, DBIL, CK-MB and a-AMY between small-dose group and large-dose group(P>0.05). The Cr levels of men and women in small-dose group and large-dose group were higher than those in the control group, and the difference was statistically significant(P<0.05). There was no statistically significant difference in abnormal rate of electrocardiogram between small-dose group and large-dose group(P>0.05). The abnormal rate of electrocardiogram 70.37% of large-dose group was less than 18.75% of small-dose group, and the difference was statistically significant(P<0.05). Follow-up patients to 2 months after poisoning, the mortality rate 44.44%(12/27) of the large-dose group was higher than 12.50%(2/16) of the small-dose group, and the difference was statistically significant(P<0.05). Pearson analysis showed that IgE had no correlation with WBC, N, ALT, AST, TBIL, DBIL, UREA, Cr, CK-MB, a-AMY(P>0.05). According to chest CT results, they were divided into normal lung group(21 cases) and lung damage group(22 cases). The IgE(430.43±618.24) mg/L of the normal lung group was lower than(1001.82±1105.68) mg/L of the lung damage group, and the difference was statistically significant(t=2.078, P=0.044<0.05). Conclusion Paraquat poisoning can cause multiple system damages. A small amount of oral administration can cause kidney damage, and can cause inflammation and immune response in the human body. A large amount of oral administration can cause liver damage, cardiac enzyme damage, and hyperamylaseemia. A large amount of oral administration can cause lung damage. The incidence of trauma is higher, and the mortality rate is higher. Increased IgE levels are related to lung damage.
作者
袁丽玲
麦子健
张伊莉
蒋文中
刘移民
YUAN Li-ling;MAI Zi-jian;ZHANG Yi-li(Guangzhou 12th People’s Hospital,Guangzhou 510000,China)
出处
《中国实用医药》
2020年第36期32-35,共4页
China Practical Medicine
基金
广州市卫生健康科技项目(项目编号:20181A010043)
广州市卫生健康委临床重点专科(项目编号:穗卫函[2019]1555号)。
