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Abstract
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OBJECTIVE: To explore the value of paraquat (PQ) intake, urine protein and myocardial enzyme indexes in judging the prognosis of patients with acute PQ poisoning.
METHODS: From September to December 2021, all 201 patients with acute PQ poisoning admitted to Guangzhou Twelfth People's Hospital from January 2010 to December 2019 were selected as the research objects. Based on follow-up results 60 days after poisoning, the research objects were divided into survival group (n=78) and death group (n=123). The differences in information about poisoning, treatment plan, PQ intake, urine protein, creatine kinase, creatine kinase isoenzyme, lactate dehydrogenase, and α-hydroxybutyrate dehydrogenase between the two groups of patients were compared and analyzed. Logistic regression and Cox regression were used to analyze the correlation between poisoning outcome and PQ intake, urine protein and myocardial enzymes. ROC curve and principal component analysis were used to explore high-efficiency indicators for predicting the outcome of acute PQ poisoning.
RESULTS: The PQ intake[50 (20, 100) ml], urine protein (total rank 15570.50) , creatine kinase[ (336.36±261.96) U/L], creatine kinase isoenzyme[ (43.91±43.74) U/L], lactate dehydrogenase [ (346.01±196.50) U/L], α-hydroxybutyrate dehydrogenase content[ (271.23±11.92) U/L] of patients in the death group were all higher than the survival group[15 (10, 20) ml, 4730.50, (187.78±178.06) U/L, (18.88±15.50) U/L, (190.92±60.50) U/L, (152.60±48.34) U/L, respectively] (P<0.05). The outcome of acute PQ poisoning was positively correlated with PQ intake, urine protein, creatine kinase, creatine kinase isoenzyme, lactate dehydrogenase, and α-hydroxybutyrate dehydrogenase (P<0.05). Multivariate logistic regression and multivariate Cox regression analysis showed that creatine kinase, creatine kinase isoenzyme, lactate dehydrogenase and α-hydroxybutyrate dehydrogenase was positively correlated with the prognosis of patients with acute PQ poisoning (P<0.05). ROC curve analysis and principal component analysis showed that the combined indexes of PQ intake, urine protein and myocardial enzymes had the highest efficacy and weight in judging the prognosis of patients (AUC=0.91, weight coefficient=0.19, sensitivity=0.76, specificity=0.89). When the combined score was ≥4, the probability of accurately predicting the death of patients was as high as 91% (positive predictive value=0.91).
CONCLUSION: PQ intake, urine protein combined with creatine kinase, creatine kinase isoenzyme, lactate dehydrogenase, and α-hydroxybutyrate dehydrogenase has high value in predicting the prognosis of patients with acute PQ poisoning.
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目的： 探讨百草枯（PQ）摄入量、尿蛋白及心肌酶指标在判断急性PQ中毒患者预后中的价值。 方法： 于2021年9至12月，选取2010年1月至2019年12月广州市第十二人民医院收治的201例急性PQ中毒患者为研究对象，根据中毒后60 d的随访结果，将研究对象分成存活组（78例）和死亡组（123例）。分析两组患者中毒信息、治疗方案、PQ摄入量、尿蛋白、肌酸激酶、肌酸激酶同工酶、乳酸脱氢酶、α-羟丁酸脱氢酶等资料的差异性，用logistic回归和Cox回归分析中毒结局与PQ摄入量、尿蛋白和各心肌酶指标之间的关联，用ROC曲线和主成分分析探索高效能预测急性PQ中毒结局的指标。 结果： 死亡组患者的PQ摄入量[50（20，100） ml]、尿蛋白（总秩次为15 570.50）、肌酸激酶[（336.36±261.96） U/L]、肌酸激酶同工酶[（43.91±43.74） U/L]、乳酸脱氢酶[（346.01±196.50） U/L]、α-羟丁酸脱氢酶含量[（271.23±11.92） U/L]均高于存活组[分别为15（10，20） ml、4 730.50、（187.78±178.06） U/L、（18.88±15.50） U/L、（190.92±60.50） U/L、（152.60±48.34） U/L]（P<0.05）。急性PQ中毒结局与PQ摄入量、尿蛋白、肌酸激酶、肌酸激酶同工酶、乳酸脱氢酶、α-羟丁酸脱氢酶均呈正向关联（P<0.05）。多因素logistic回归和多因素Cox回归分析显示，肌酸激酶、肌酸激酶同工酶、乳酸脱氢酶、α-羟丁酸脱氢酶与急性PQ中毒患者预后均呈正向关联（P<0.05）。ROC曲线和主成分分析显示，PQ摄入量、尿蛋白和各心肌酶联合指标在判断患者预后的效能和权重最高（AUC=0.91，权重系数=0.19，灵敏度=0.76，特异度=0.89）；当联合得分≥4分时，准确预测患者死亡的概率为91%（阳性预测值=0.91）。 结论： PQ摄入量、尿蛋白联合肌酸激酶、肌酸激酶同工酶、乳酸脱氢酶、α-羟丁酸脱氢酶判断急性PQ中毒患者预后具有较高的价值。
Language: zh |