肝脏酶谱变化对急性百草枯中毒患者的预后作用的研究

黄昌保; 孙兆瑞; 杨志洲; 聂时南

doi:10.13201/j.issn.1009-5918.2016.11.002

肝脏酶谱变化对急性百草枯中毒患者的预后作用的研究

- 南京军区南京总医院(南京大学附属金陵医院)急救医学科(南京, 210002)
基金项目:
国家自然科学基金青年基金课题(No:81401583)

江苏省博士后基金(No:1402145C)

协和-睿E基金(No:R2014004)

详细信息

通讯作者: 聂时南,E-mail:shn_nie@sina.com

中图分类号: R595.4

收稿日期: 2016-10-09

Spectrum of acute toxic hepatitis in intentional paraquat poisoning patients

- Department of Emergency Medicine, Jinling Hospital of Medical School of Nanjing University, Nanjing 210002, China

More Information

Corresponding author: NIE Shinan, E-mail: shn_nie@sina.com

Received Date: 09 October 2016

摘要

摘要: 目的:回顾性研究急性百草枯(Paraquat,PQ)中毒患者的肝脏酶谱变化,评价急性PQ中毒的危险因素及预后。方法:回顾性分析我院近6年收治的急性PQ中毒患者,按照ALT是否达到正常上限3倍以上分为急性肝损伤组和非肝损伤组,分析评价患者的一般情况、生化及动脉血气分析数据等,同时也分析急性肝损伤危险因素、2组的生存率差异等。结果:共320例急性PQ中毒患者入选本研究,其中134例发生急性肝损伤,占41.9%,急性肝损伤发生的平均时间为(3.6±1.3) d,ALT平均为413(IQR,227.8~614.3) U/L,其中最高值为4 040 U/L。急性肝损伤组与非肝损伤组比较,2组患者在口服量[(73.0±58.2) ml vs.(41.8±42.0) ml,P<0.01)]、血PQ浓度[(2.0±1.8) μg/ml vs.(0.7±1.1) μg/ml,P<0.01)],就诊时间[(6.1±3.4) h vs.(5.2±3.1) h,P=0.015)]差异有统计学意义,急性肝损伤组患者肾损伤发生率、低氧血症发生率及胰腺损伤发生率均明显高于非肝损伤组(81.3% vs.36.6%,P<0.01;65.7% vs.22.0%,P<0.01;32.8% vs.4.3%,P<0.01),2组患者死亡率差异有统计学意义(78.4% vs.18.8%,P<0.01),急性肝损伤是急性PQ中毒的死亡危险因素之一(HR=1.921,95%CI 1.011~3.649,P=0.046)。结论:急性肝损伤是急性PQ中毒的常见并发症,也是急性PQ中毒的死亡危险因素,总之,急性PQ中毒导致急性肝损伤一般出现在1周内,且多较严重。
- 急性百草枯中毒 /
- 急性肝损伤 /
- 危险因素
Abstract: Objective:The liver is one of the main target organs of paraquat poisoning,while there are little clinical researches studying the toxic hepatitis of paraquat poisoning.This retrospective research studied the demographic data,clinical features,and outcome after paraquat poisoning,and evaluated the risk factors of toxic hepatitis after paraquat intoxication.Method:We retrospective studied the clinical data of paraquat poisoning patients in recently five years.Patients were categorized into toxic hepatitis group and non-toxic hepatitis group according to their serum ALT level.Demographic,bio-chemical and artery blood gas analysis data were obtained for analysis.Mortality rates and risk factors of toxic hepatitis were also analyzed.Result:A total of 320 patients with acute paraquat poisoning were included in this study,among these,134 patients (41.9%) had toxic hepatitis within (3.6±1.3) d after exposure to paraquat with ALT 413(IQR,227.8~614.3) U/L and the peak value of ALT was 4040 U/L.The toxic hepatitis group had more ingestion amount of paraquat [(73.0±58.2) ml vs.(41.8±42.0) ml,P<0.01)],higher plasma paraquat concentration [(2.0±1.8) μg/ml vs.(0.7±1.1) μg/ml,P<0.01)],and longer time from ingestion to ED [(6.1±3.4) h vs.(5.2±3.1) h,P=0.015)].The toxic hepatitis group also suffered from greater incidences of acute kidney failureand hypoxemia and acute pancreas injury than patients without hepatitis (81.3% vs.36.6%,P<0.01;65.7% vs.22.0%,P<0.01;32.8% vs.4.3%,P<0.01).The overall mortality rate was 43.8% (140/320),and the mortality rate in toxic hepatitis group was higher than non-toxic hepatitis group (78.4% vs.18.8%,P<0.01).A multivariate Cox regression analysis revealed that the toxic hepatitis was correlated with increased hazard ratios (HR) for all-cause mortality (HR=1.921,95%CI 1.011-3.649,P=0.046).Conclusion:Toxic hepatitis was a common complication of paraquat poisoning,and also was a risk factor of all-cause mortality rate.Toxic hepatitis generally appeared within a week,and the spectrum of hepatitis seemed more seriously.
- sacute paraquat poisoning /
- toxic hepatitis /
- risk factors

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