摘要
目的探讨急性有机磷中毒(acute organophosphonis poisoning, AOPP)患者中性粒细胞计数冲性粒细胞-淋巴细胞比值、急性生理学与慢性健康状况评分系统Ⅱ评分与其严重程度的关系。方法参照急性有机磷农药中毒诊治临床专家共识(2016)将2014年12月-2017年12月入住于徐州医科大学附属医院的62例AOPP患者分为两组,即轻中度中毒组和重度中毒组,比较两组患者性别、年龄、中毒至入院时间、中毒途径、摄入量及入院后首次采集的血白细胞计数、NC、淋巴细胞计数、NLR、血红蛋白、血尿素、血肌肝、总胆红素、直接胆红素、白蛋白、谷丙转氨酶、谷草转氨酶、血钠、血钾、红细胞分布宽度、胆碱酯酶活力,APACHE Ⅱ评分等指标的差异。差异有统计学意义的指标进行二元logistic回归分析,并对独立风险因素进行ROC曲线分析,利用ROC曲线坐标及约登指数计算最佳诊断截值.结果①重度组患者NC、NLR、谷草转氨酶、红细胞分布宽度、APACHE Ⅱ评分高于轻中度组患者,ChE活力低于轻中度组(P<0.05)。②NC、NLB、APACHE Ⅱ评分是预测急性有机磷中毒严重程度的独立预测因素。③NC、NLR、APACHE Ⅱ评分的ROC曲线下面积分别为0.839(95%CI 0.724-0.953)、0.906(95%C1 0.828-0.984)、0.882(95%CI 0.801 - 0.963),最佳诊断截值分别为 7.575(敏感性 82.9%,特异性81.0%,约登指数0.639)、10.845(敏感性80.5%,特异性85.7%,约登指数0.662)和15.000(敏感性68.3%,特异性100%,约登指数0.683).结论NC、NLR、APACHE Ⅱ评分对判断AOPP中毒程度有重要价值。
Objective The purpose of this study was to investigate the relationship between the severity of acute organophosphorus poisoning (AOPP) and NC、NLR and APACHEⅡ score. Method 62 patients with AOPP included in the study were divided into two groups: mild to moderate poisoning group and severe poisoning group according to the clinical consensus of diagnosis and treatment of acute organophosphorus pesticide poisoning.The differengces between the two groups were compared,including Sex, age, time from poisoningto admission, route of poisoning, intake and firstblood leukocyte count, neutrophil count, lymphocyte count, neutrophil to lymphocyte ratio,hemoglobin.blood urea, serum creatinine, total bilirubin, direct bilimbin, albumin, alanine aminotransferase, aspartate aminotransferase,serum sodium, blood potassium, red blood cell distribution width, cholinesterase activity and APACHEⅡ score and so on.The statistically significant indexes were analyzed by binaiy logistic regression analysis, and the independent risk factors were analyzed by ROC curve. The best diagnostic cutoff was calculated by ROC curve coordinate and Youden's index. Results 1. Neutrophil count, neutrophil to lymphocyte ratio, aspartate aminotransferase, erythrocyte distribution width, cholinesterase activity and APACHEⅡ score in severe group were higher than those in mild and moderate group (P <0.05).2.The NC s NLR and APACHEⅡ score are independent predictors of the severity of acute organophosphonis poisoning.3.The area under the ROC curve of the NC、NLR、APACHEⅡ score respectively was 0.839(95% CI, 0.724-0.953) and the optimal cut-off value was 7.575 (sensitivity. 82.90%: specificity, 81.00%;Youden's index,0.639)、0.906(95%CI, 0.828-0.984) and the optimal cut-off value was 10.845 (sensitivity, 80.50%;specificity, 85.70%;Youden's index, 0.662)、0.882(95% Cl, 1.097-1.769) and the optimal cut-off value was 15.00 (sensitivity, 68.30%;specificity, 100.00%;Youden's index, 0.683). Conclusions The NC、NLR and APACHEⅡ score were of great value in judging the severity of AOPP poisoning.
作者
张娜
许铁
ZHANG Na;XU Tie(Emergency Center of the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002 China)
出处
《中国急救复苏与灾害医学杂志》
2019年第3期218-221,共4页
China Journal of Emergency Resuscitation and Disaster Medicine
