摘要
目的分析百草枯中毒肺纤维化患者免疫球蛋白(Ig)G、IgA、IgM水平的检测意义。方法选取32例口服百草枯中毒致肺纤维化患者,根据预后分为死亡组(14例)和存活组(18例)。另选取同时期20例体检健康人员作为对照组。对百草枯中毒致肺纤维化患者进行洗胃,口服甘露醇导泻治疗,进行血液灌流治疗连续3 d,并给予谷胱甘肽护肝、奥美拉唑护胃、磷酸肌酸营养心肌、糖皮质激素治疗。检测并比较三组免疫球蛋白水平,分析死亡组和存活组胸部CT结果及预后。结果死亡组口服20%百草枯溶液量大于存活组,差异有统计学意义(P<0.05)。第1天,三组IgG、IgA、IgM水平比较,差异均无统计学意义(P>0.05)。第15天,存活组患者IgG、IgA、IgM水平分别为(7.57±2.29)、(1.22±0.42)、(0.85±0.24)g/L,均低于死亡组的(10.80±3.75)、(1.81±0.64)、(1.09±0.40)g/L,且低于第1天的(10.90±1.54)、(1.86±0.53)、(1.13±0.38)g/L,差异均具有统计学意义(P<0.05)。死亡组第15天IgG、IgA、IgM水平较第1天下降,但差异无统计学意义(P>0.05)。死亡组患者第1天有8例出现轻度肺水肿,胸部CT表现为淡薄磨玻璃影;第15天出现多发性肺纤维化,胸部CT表现为双肺多发条索状、片状密度增高影;第20天至第34天死亡。存活组第1天5例出现轻度肺水肿, 13例正常;第15天均出现肺部分纤维化;第30天复查肺纤维化较前吸收好转。结论百草枯中毒肺纤维化患者在病程中监测Ig G、Ig A、Ig M水平对于评估病情变化、治疗效果和预后有重要意义,抑制体液免疫可减轻肺纤维化进展。
Objective To analyze the clinical significance of immunoglobulin(Ig) G, IgA, IgM levels and prognosis in patients with pulmonary fibrosis poisoned by paraquat. Methods A total of 32 patients with pulmonary fibrosis poisoned by paraquat were divided into death group(14 cases) and survival group(18 cases) according to their prognosis. 20 healthy subjects with physical examination during the same period were selected as the control group. Patients were given gastric lavage, oral mannitol catharsis therapy, hemoperfusion therapy for 3 consecutive days, and given glutathione to protect the liver, omeprazole to protect the stomach, creatine phosphate nutrition myocardium, and glucocorticoid therapy. The immunoglobulin levels of the three groups was detected and compared, and the chest CT results and prognosis of the death group and the survival group was analyzed. Results The dosage of 20% paraquat in the death group was higher than that in the survival group, and the difference was statistically significant(P<0.05). On 1 st day, there was no statistically significant difference in IgG, IgA and IgM among three groups(P>0.05). On the 15 th day, the levels of IgG, IgA and IgM in the survival group were(7.57±2.29),(1.22±0.42),(0.85±0.24) g/L, which were lower than(10.80±3.75),(1.81±0.64),(1.09±0.40) g/L of the death group, and(10.90±1.54),(1.86±0.53),(1.13±0.38) g/L on the first day, and the differences were statistically significant(P<0.05). The levels of IgG, IgA and IgM in the death group on the 15 th day were lower than those on the 1 st day, but the difference was not statistically significant(P>0.05). In the death group, 8 patients developed mild pulmonary edema on the 1 st day, and the chest CT showed light groundglass shadow;on the 15 th day, multiple pulmonary fibrosis appeared, and the chest CT showed multiple lungs with multiple strands and patches of increased density;Died from day 20-34 day. In the survival group, 5 cases developed mild pulmonary edema on 1 st day and 13 cases were normal. Partial pulmonary fibrosis appeared on 15 th day;pulmonary fibrosis was rechecked on 30 th day and the absorption improved. Conclusion Monitoring the levels of IgG, IgA and IgM in patients with paraquat poisoned by pulmonary fibrosis during the course of the disease is of great significance to evaluate the changes of the disease, treatment effect and prognosis. Inhibition of humoral immunity can reduce the progress of pulmonary fibrosis.
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34期24-26,共3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)。
关键词
百草枯
免疫球蛋白
肺纤维化
Paraquat
Immunoglobulin
Pulmonary fibrosis
