BACKGROUND:Heatstroke has become a common emergency event in hospitals.Procalcitonin(PCT)is used as a biomarker of infection in the emergency department(ED),but its role in rhabdomyolysis(RM)following exertional heats...BACKGROUND:Heatstroke has become a common emergency event in hospitals.Procalcitonin(PCT)is used as a biomarker of infection in the emergency department(ED),but its role in rhabdomyolysis(RM)following exertional heatstroke(EHS)remains unclear.METHODS:A retrospective cohort study enrolled patients with EHS from the intensive care unit(ICU).We collected RM biomarkers,inflammation markers,critical disease scores at admission,24 h,48 h,and discharge,and 90-day mortality.Correlation analysis,linear regression and curve fi tting were used to identify the relationship between PCT and RM.RESULTS:A total of 162 patients were recruited and divided into RM(n=56)and non-RM(n=106)groups.PCT was positively correlated with myoglobin(Mb),acute hepatic injury,disseminated intravascular coagulation(DIC),Sequential Organ Failure Assessment(SOFA)score,and Acute Physiology and Chronic Health Evaluation II(APACHE II)score,with correlation coefficients of 0.214,0.237,0.285,0.454,and 0.368,respectively(all P<0.05).Interestingly,the results of curve fi tting revealed a nonlinear relationship between PCT and RM,and a two-piecewise linear regression model showed that PCT was related to RM with an odds ratio of 1.3 and a cut-off of<4.6 ng/mL.Survival analysis revealed that RM was associated with higher mortality compared to non-RM cases(P=0.0093).CONCLUSION:High serum PCT concentrations are associated with RM after EHS in critically ill patients.Elevated PCT concentrations should be interpreted cautiously in patients with EHS in the ED.展开更多
目的了解药物相关性横纹肌溶解症(RM)的发生特点,为合理用药提供依据。方法以RM为主题词,检索2002年1月~2022年11月中国知网全文数据库(CNKI)、万方数字化期刊全文库有关药物相关性RM的报道,剔除资料不全、重复案例、综述以及非药物所...目的了解药物相关性横纹肌溶解症(RM)的发生特点,为合理用药提供依据。方法以RM为主题词,检索2002年1月~2022年11月中国知网全文数据库(CNKI)、万方数字化期刊全文库有关药物相关性RM的报道,剔除资料不全、重复案例、综述以及非药物所致、药物过量和中毒引起药物相关性RM的案例。统计分析文献筛选结果,患者的一般情况、病史情况,引起药物相关性RM的药物分布及帕累托图,RM发生时间,转归情况。结果检索到药物相关性RM的原始报道个案321篇,剔除剔除资料不全、重复案例、综述、以及药物过量和中毒引起的药物相关性RM的案例40篇,最终纳入符合条件的报道281篇,共计病例300例。300例药物相关性RM患者中,男性155例,占51.67%;女性145例,占48.33%,男女比例为1.07∶1;年龄3~93岁。300例药物相关性RM患者的原患疾病主要为高血脂、冠心病、感染性疾病等,其中14例既往有过敏史,76例有糖尿病,47例有慢性肾功能不全、衰竭,34例存在低血钾,18例存在甲状腺功能减退。300例药物相关性RM患者中单一用药所致的RM共计231例,占77.00%,涉及18类药物。帕累托图分析得出:累积百分比在0~80%之间的因素:血脂调节药、抗感染药,此类因素为A类因素,即主要因素;累积百分比在80%~90%之间的因素:甘草及其有效成分、精神类药、抗肿瘤药,此类因素为B类因素,即次要因素;累积百分比在90%~100%之间的因素:非甾体抗炎药、降压药、利尿剂、麻醉及辅助用药、妇科用药、减肥药、激素及有关药、抗痛风药、降糖药、抗癫痫药、消化系统药、血管保护药、抗痤疮药,此类因素为C类,即最次因素。联合用药(2种及以上药物)所致的RM共计69例,占23.00%,其中大部分报道为与他汀类药物联用所致,共计59例,占85.51%。300例药物相关性RM患者中,RM发生时间<24 h共10例,占3.33%;1~10 d 117例,占39.00%;10~30 d 82例,占27.33%;1~3个月38例,占12.67%;3个月~1年12例,占4.00%;1~3年16例,占5.33%;>3年10例,占3.33%;不详15例,占5.00%。其中发生药物相关性RM最短时间为用药后20 min(1例),最长时间的则发生在用药后10年(3例)。300例药物相关性RM患者中,好转284例,占94.67%;致终身性肾功能损害1例,占0.33%;死亡7例,占2.33%;不详8例,占2.67%。结论多种药物可致RM,临床用药时应密切关注患者情况,以确保用药安全。展开更多
基金funded by the National Natural Science Foundation of China(82072143,81873943,82360903)Sanming Project of Medicine in Shenzhen(SZSM20162011)+3 种基金Shenzhen Science and Technology Innovation Commission(JCYJ20190806163603504)Shenzhen Second People’s Hospital Clinical Research Fund of Guangdong Province High-level Hospital Construction Project(20203357014,2023xgyj3357001,2023yjlcyj022)Guizhou Science and Technology Planning Project(Guizhou Science and Technology Cooperation Support[2021]General 413)and PhD Start-up Fund(GYZYYFY-BS-2023[09]).
文摘BACKGROUND:Heatstroke has become a common emergency event in hospitals.Procalcitonin(PCT)is used as a biomarker of infection in the emergency department(ED),but its role in rhabdomyolysis(RM)following exertional heatstroke(EHS)remains unclear.METHODS:A retrospective cohort study enrolled patients with EHS from the intensive care unit(ICU).We collected RM biomarkers,inflammation markers,critical disease scores at admission,24 h,48 h,and discharge,and 90-day mortality.Correlation analysis,linear regression and curve fi tting were used to identify the relationship between PCT and RM.RESULTS:A total of 162 patients were recruited and divided into RM(n=56)and non-RM(n=106)groups.PCT was positively correlated with myoglobin(Mb),acute hepatic injury,disseminated intravascular coagulation(DIC),Sequential Organ Failure Assessment(SOFA)score,and Acute Physiology and Chronic Health Evaluation II(APACHE II)score,with correlation coefficients of 0.214,0.237,0.285,0.454,and 0.368,respectively(all P<0.05).Interestingly,the results of curve fi tting revealed a nonlinear relationship between PCT and RM,and a two-piecewise linear regression model showed that PCT was related to RM with an odds ratio of 1.3 and a cut-off of<4.6 ng/mL.Survival analysis revealed that RM was associated with higher mortality compared to non-RM cases(P=0.0093).CONCLUSION:High serum PCT concentrations are associated with RM after EHS in critically ill patients.Elevated PCT concentrations should be interpreted cautiously in patients with EHS in the ED.
文摘目的了解药物相关性横纹肌溶解症(RM)的发生特点,为合理用药提供依据。方法以RM为主题词,检索2002年1月~2022年11月中国知网全文数据库(CNKI)、万方数字化期刊全文库有关药物相关性RM的报道,剔除资料不全、重复案例、综述以及非药物所致、药物过量和中毒引起药物相关性RM的案例。统计分析文献筛选结果,患者的一般情况、病史情况,引起药物相关性RM的药物分布及帕累托图,RM发生时间,转归情况。结果检索到药物相关性RM的原始报道个案321篇,剔除剔除资料不全、重复案例、综述、以及药物过量和中毒引起的药物相关性RM的案例40篇,最终纳入符合条件的报道281篇,共计病例300例。300例药物相关性RM患者中,男性155例,占51.67%;女性145例,占48.33%,男女比例为1.07∶1;年龄3~93岁。300例药物相关性RM患者的原患疾病主要为高血脂、冠心病、感染性疾病等,其中14例既往有过敏史,76例有糖尿病,47例有慢性肾功能不全、衰竭,34例存在低血钾,18例存在甲状腺功能减退。300例药物相关性RM患者中单一用药所致的RM共计231例,占77.00%,涉及18类药物。帕累托图分析得出:累积百分比在0~80%之间的因素:血脂调节药、抗感染药,此类因素为A类因素,即主要因素;累积百分比在80%~90%之间的因素:甘草及其有效成分、精神类药、抗肿瘤药,此类因素为B类因素,即次要因素;累积百分比在90%~100%之间的因素:非甾体抗炎药、降压药、利尿剂、麻醉及辅助用药、妇科用药、减肥药、激素及有关药、抗痛风药、降糖药、抗癫痫药、消化系统药、血管保护药、抗痤疮药,此类因素为C类,即最次因素。联合用药(2种及以上药物)所致的RM共计69例,占23.00%,其中大部分报道为与他汀类药物联用所致,共计59例,占85.51%。300例药物相关性RM患者中,RM发生时间<24 h共10例,占3.33%;1~10 d 117例,占39.00%;10~30 d 82例,占27.33%;1~3个月38例,占12.67%;3个月~1年12例,占4.00%;1~3年16例,占5.33%;>3年10例,占3.33%;不详15例,占5.00%。其中发生药物相关性RM最短时间为用药后20 min(1例),最长时间的则发生在用药后10年(3例)。300例药物相关性RM患者中,好转284例,占94.67%;致终身性肾功能损害1例,占0.33%;死亡7例,占2.33%;不详8例,占2.67%。结论多种药物可致RM,临床用药时应密切关注患者情况,以确保用药安全。
