摘要
目的 探讨血清乳酸水平对急性百草枯中毒（APP）患者预后的预测价值.方法 回顾性分析168例APP患者的临床资料,收集患者入院时的血清乳酸水平和血浆百草枯浓度,计算百草枯中毒严重指数（SIPP）,并根据SIPP将患者分为＜10、10 ～ 50、≥50 h·mg·L-1 3组,分析血清乳酸水平与SIPP的相关性及对预后的预测价值.结果 SIPP水平越高,患者乳酸水平（mmol/L）越高[200（1.50,2.83）、3.10（1.73,5.15）、8.95（5.90,13.10）,均P＜ 0.05]；SIPP与血清乳酸水平呈正相关（r=0.569,P＜0.05）.SIPP水平越高,患者病死率越高 [17.4％（15/86）、61.5％（24/39）、97.7％（42/43）,均P＜0.05]；SIPP≥50 h·mg· L-1组死亡患者的生存时间（d）明显短于SIPP＜ 10 h·mg· L-1组和10～ 50 h·mg· L-1组[2.0（1.0,3.0）比9.0（4.0,11.0）、5.0（3.0,10.0）,均P＜0.05]；乳酸水平及SIPP与死亡患者生存时间均呈显著负相关（r1=-0.778,r2=-0.621,均P＜0.05）；logistic回归分析显示,乳酸、SIPP与预后有关[乳酸：优势比（OR）=1.758,95％可信区间（95％CI）为1.278 ～ 2.417；SIPP：OR=1.063,95％CI为1.025 ～ 1.103,均P=0.001]；乳酸及SIPP与预后的受试者工作特征曲线（ROC曲线）下面积分别为0.885和0.897（均P＜ 0.05）,乳酸≥3.35 mmol/L为最佳界值,其对预测患者死亡的敏感度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比和准确度分别为74.07％、90.80％、88.24％、79.00％、8.056、0.286和82.74％,预测价值接近于SIPP≥13.83 h·mg·L-1的界值（77.78％、91.95％、90.00％、81.63％、9.677、0.242和85.12％）.结论 血清乳酸水平的变化对于APP患者的严重程度及预后具有评估价值,以乳酸≥3.35 mmol/L为界值可作为一种简便易行的指标推断APP患者的预后.
Objective To discuss the role of serum lactic acid （Lac） level in evaluation of prognosis of acute paraquat poisoning （APP） patients.Methods Clinical data from 168 APP patients were retrospectively analyzed.The serum Lac level and the plasma paraquat concentrations at admission were collected,and the severity index of paraqaut poisoning （SIPP） were calculated.The patients were divided into 〈 10,10-50,≥ 50 h·mg· L-1 groups on the basis of SIPP.The correlation between Lac and SIPP was analyzed,as well as the role in evaluating prognosis.Results The higher the SIPP level,the higher the Lac level [mmol/L：2.00 （1.50,2.83）,3.10 （1.73,5.15）,8.95 （5.90,13.10）,all P〈0.05] ; Lac was correlated positively with SIPP （r=0.569,P〈0.05）.The higher the SIPP,the higher the mortality of patients [17.4% （15/86）,61.5% （24/39）,97.7% （42/43）,all P〈0.05].The survival days of SIPP≥50 h ·mg·L-1 group was shorter than that in SIPP〈 10 h·mg·L-1 group and 10-50 h·mg·L-1 group [2.0 （1.0,3.0） vs.9.0 （4.0,11.0）and 5.0 （3.0,10.0）,both P〈0.05].A negative correlation was found between Lac,SIPP and survival days in non-survivors （r1 =-0.778,r2=-0.621,both P〈0.05）.Logistic regression analyses showed either Lac or SIPP was of prognostic significance [odds ratio （OR） of Lac：1.758,95% confidence interval （95% CI） 1.278-2.417; OR of SIPP：1.063,95%CI 1.025-1.103,both P=0.001].The area under the receiver operating characteristic curve （ROC curve） of Lac,SIPP and prognosis were 0.885 and 0.897 respectively （both P〈0.05）,Lac ≥ 3.35 mmol/L was the best cut-off value,the sensitivity,specificity,positive predictive value,negative predictive value,positive likelihood ratio,negative likelihood ratio and accuracy for predicting the death were 74.07%,90.80%,88.24%,79.00%,8.056,0.286 and 82.74% respectively; the evaluation value was closed to SIPP≥ 13.83 h·mg·L-1 （77.78%,91.95%,90.00%,81.63%,9.677,0.242 and 85.12%,respectively）.Conclusion The change in serum Lac level has evaluation value of the severity and prognosis for APP patients,and Lac ≥ 3.35 mmol/L can be made as a simple and easy indicator for prognosis of APP patients.
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2013年第9期519-522,共4页
Chinese Critical Care Medicine
基金
国家自然科学基金（30900493）
关键词
百草枯
中毒
乳酸
百草枯中毒严重指数
预后
Paraquat
Poisoning
Lactic acid
Severity index of paraqaut poisoning
Prognosis
