关键词:

百草枯, 急性中毒, 预后, 影响因素

Abstract:

Objective　To explore the main factors affecting the prognosis in patients with acute paraquat poisoning simply and efficiently. Methods　Using the method of retrospective study, 201 patients with acute paraquat poisoning who were hospitalized in Guangzhou Twelfth People's Hospital from January 2010 to December 2019 were selected as the research objects, and according to the conditions at discharge and the follow-up results 60 days after poisoning, the subjects were divided into a survival group (78 cases) and a death group (123 cases). The differences of basic information, diagnosis and treatment plans, and laboratory test indicators at admission between the two groups were compared. The binary logistic regression analysis was used to screen out the main influencing factors that could independently predict the outcome of poisoning. The receiver operating characteristic curve (ROC) was used to determine the effectiveness of the main influencing factors in identifying the prognosis in patients with acute paraquat poisoning. t test and χ² test were used. Results　In the survival group, there were 33 males and 45 females, aged (30.41±14.04) years. In the death group, there were 61 males and 62 females, aged (31.86±14.15) years. In the survival group, the paraquat intake [(20.95±23.14) ml], proportion of vomiting symptom [70.51% (55/78)], white blood cell count (WBC) [(12.39±4.93) ×10⁹/L], hemoglobin (Hb) [(136.56±18.04) g/L], prothrombin time (PT) [(12.49±3.52) s], alanine transaminase (ALT) [(18.30±10.76) U/L], aspartate aminotransferase (AST) [(23.44±11.85) U/L], blood glucose [(7.09±2.21) mmol/L], urea nitrogen [(4.96±3.48) mmol/L], creatinine [(98.03±79.33) μmol/L], creatine kinase (CK) [(187.78±178.06) U/L], creatine kinase isoenzyme (CKMB) [(18.88±15.50) U/L], lactate dehydrogenase (LDH) [(190.92±60.50) U/L], and urine protein average ranks (60.65) were lower than those in the death group [(62.07±50.59) ml, 83.74% (103/123), (23.15±12.05) ×10⁹/L, (142.32±20.64) g/L, (13.50±3.13) s, (94.04±144.42) U/L, (130.94±184.19) U/L, (8.43±3.49) mmol/L, (9.55±8.17) mmol/L, (249.98±196.40) μmol/L, (336.36±261.96) U/L, (43.91±43.74) U/L, (346.01±196.50) U/L, and 126.59], with statistically significant differences (all P<0.05). The blood partial pressure of carbon dioxide (PaCO₂) [(4.33±0.58) kPa] and blood bicarbonate (HCO₃^-) concentration [(21.12±2.36) mmol/L] in the survival group were higher than those in the death group [(3.81±1.25) kPa and (16.85±4.75) mmol/L], with statistically significant differences (both P<0.05). Binary logistic regression analysis showed that paraquat intake (OR=1.022, P<0.05), HCO₃^- (OR=0.763, P<0.05), AST (OR=1.059, P<0.05), blood glucose (OR=1.235, P<0.05), and urinary protein (OR=1.878, P<0.05) were key indicators of prognosis in patients with acute paraquat poisoning. Further ROC analysis showed that the five indexes had high efficacies in predicting the prognosis in patients with acute paraquat poisoning, among which AST was the index with the highest predictive value [the area under the curve (AUC) was 0.87, and the optimal diagnostic value was 35.30 U/L], urinary protein was the index with the highest sensitivity (0.94), HCO₃^- and AST were the indexes with the highest specificity (both 0.96), HCO₃^- and AST were the indexes with the highest positive predictive value (both 0.96), and urinary protein was the index with the highest negative predictive value (0.86). Conclusions　Paraquat intake, HCO₃^-, AST, blood glucose, and urinary protein are the main influencing factors for predicting the outcome of acute paraquat poisoning. They have high predictive efficacy, sensitivity, and specificity, and can be used to independently identify the prognosis in patients with acute paraquat poisoning.

Key words:

Paraquat, Acute poisoning, Prognosis, Influencing factors