摘要
目的探讨服毒量对于评估急性百草枯中毒(APP)患者预后的准确性。方法回顾性分析225例APP患者的年龄、服毒量、血清百草枯浓度及中毒时间,计算服毒量和APP严重指数(SIPP)的受试者工作特征(ROC)曲线下面积,通过服毒量的cutoff值、SIPP、Jones生存回归方程和Proudfoot生存曲线推断患者预后。结果只有百草枯浓度及中毒时间进入Logistic回归方程。服毒量与SIPP的ROC曲线下面积分别为0.784和0.916。中毒200 h内的患者,服毒量除特异性稍高于Jones生存回归方程外,其余诊断性试验指标均最低。中毒4～24 h间的患者,虽然服毒量的特异性、阳性预测值和阳性似然比稍高于Jones生存回归方程,但其敏感性、阴性预测值和准确度均为最低。结论服毒量不能准确评估APP患者的预后,血清百草枯浓度及中毒时间仍是较为可靠的预测指标,在不能测定百草枯浓度的情况下,可通过血乳酸等早期变化的实验室指标对APP患者进行快速的预后评估。
Objective：To discuss the prognostic accuracy of poisoning dose in evaluation of acute paraquat poisoning（APP） patients.Methods：The age,poisoning dose,plasma paraquat concentration and time from poisoning to arrival of 225 APP patients were reviewed.The area under the Receiver Operating Characteristic（ROC） curve of poisoning dose and Severity Index of Paraqaut Poisoning（SIPP） were calculated.Meanwhile,the prognosis by cutoff value of poisoning dose and SIPP,as well as Jones regression equation and Proudfoot survival curve were predicted.Results：The plasma paraquat concentration and time from poisoning to arrival were correlated with prognosis by logistic regression analysis.The area under ROC curve of poisoning dose and SIPP was 0.784 and 0.916 respectively.For time less than 200 hours,the specificity of the poisoning dose was higher than that of the Jones regression equation,but the value of others indexes were the lowest.For time between 4 and 24 hours,the specificity,positive predictive value and positive likelihood ratio of poisoning dose were higher than Jones regression equation,but the sensitivity,negative predictive value and degree of accuracy were the lowest.Conclusion：The poisoning dose cannot evaluate the prognosis of APP patients accurately.The plasma paraquat concentration and time from poisoning to arrival are still reliable indices.In the condition that plasma paraquat concentration is not available,we can evaluate the prognosis of APP patients by laboratory parameters,such as lactic acid,which changes early after paraquat poisoning.
出处
《中国中医急症》
2013年第7期1094-1096,共3页
Journal of Emergency in Traditional Chinese Medicine
基金
国家自然科学基金青年科学基金项目(30900493)
关键词
百草枯中毒
服毒量
血药浓度
预后
Paraquat poisoning
Poisoning dose
Plasma concentration
Prognosis
