摘要 摘 要:为研究敌草快(DQ)中毒病人的临床特点,评估中毒病人脑损伤的相关因素及其分子机制,本研究收集DQ中毒病人56例,按住院期间病人脑损伤情况分为脑损伤组14例和未损伤组42例,并比较两组病人的基线资料和实验室指标。利用logistic回归分析DQ中毒病人脑损伤的相关因素,利用受试者操作特征(ROC)曲线分析比较以上相关因素单独或联合时对DQ中毒病人脑损伤状态的预测价值。分组比较结果显示,脑损伤组病人的体质量指数(BMI)、DQ阳离子中毒剂量、接受机械通气、接受连续性肾脏替代治疗(CRRT)的比例显著高于未损伤组(P<0.05)。脑损伤组病人入院后S100钙结合蛋白B(S100B)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、尿素氮(BUN)、肌酐(SCR)等血清生化指标,以及中毒后24 h的白细胞(WBC)计数、中性粒细胞计数、中性粒细胞与淋巴细胞比率(NLR)均显著高于未损伤组(P<0.05)。对分组比较中存在显著差异的变量按先单因素后多因素方式进行logistic回归分析,回归结果显示,中毒后24 h NLR对DQ中毒病人脑损伤状态有一定的独立预测价值。ROC曲线分析比较结果进一步表明,当中毒后24 h NLR联合BMI、DQ阳离子中毒剂量,或中毒后24 h NLR联合BMI、血液灌流前血液DQ质量浓度时,相比于单一指标可获得对DQ中毒病人脑损伤状态更高的预测价值。DQ中毒病人中毒后24 h NLR水平升高与脑损伤增加显著相关,可作为病人住院期间脑损伤发生的独立预测因子,当中毒后24 h NLR联合BMI及DQ阳离子中毒剂量、血液DQ质量浓度时可获得对脑损伤事件更高的预测价值。
关键词:敌草快;脑损伤;中毒剂量;中性粒细胞与淋巴细胞比率(NLR) ;预测
中图分类号:R446.1;R34 文献标志码:A DOI:10.3969/j.issn.1007-7146.2023.05.010
Abstract:Abstract: In order to study the clinical characteristics of diquat poisoning patients and evaluate the related factors and molecular mechanism of brain injury in diquat poisoning patients, this study collected 56 patients with diquat poisoning and divided them into a brain injury group of 14 cases and a non-injury group of 42 cases based on their brain injury status during hospitalization, and compared the baseline data and laboratory indicators of patients between the two groups. The study analyzed the relevant factors of brain injury in diquat poisoning patients using logistic regression, and used receiver operating characteristic (ROC) curve analysis to compare the predictive value of the above related factors alone or in combination on the brain injury status of diquat poisoning patients. The grouping comparison results showed that body mass index (BMI), diquat cation poisoning dose, the proportion of mechanical ventilation, and the proportion of continuous renal replacement therapy (CRRT) in the brain injury group were significantly higher than those in the non-injury group (P<0.05) . The serum biochemical indicators in the brain injury group such as S100 calcium binding protein B (S100B), alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), serum creatinine (SCR) after admission and the white blood cell (WBC) count, neutrophil count, neutrophil to lymphocyte ratio (NLR) at 24 hours after poisoning were significantly higher than those in the uninjured group (P<0.05) . A method of univariate regression followed by multivariate regression analysis was taken to analyse the variables with significant differences in group comparison, and the results of regression showed that the 24-hour NLR after poisoning has certain independent predictive value for the brain injury status of patients with diquat poisoning. The comparison results of ROC curve analysis further indicated that when NLR at 24 hours after poisoning was combined with BMI and the diquat cation poisoning dosage, or NLR at 24 hours after poisoning was combined with BMI and the concentration of diquat in the blood before hemoperfusion, a higher predictive value can be obtained for the brain injury status of diquat poisoning patients. The increase of 24-hour NLR level after diquat poisoning is significantly correlated with the increase of brain injury, which can be used as an independent predictor of the occurrence of brain injury during hospitalization, and when 24-hour NLR is combined with BMI, diquat cation poisoning dose and blood diquat concentration, a higher predictive value of brain injury events can be obtained.
Key words: diquat; brain injury; poisoning dose; neutrophil to lymphocyte ratio; prediction
(Acta Laser Biology Sinica, 2023, 32(5): 473-480)
引用本文:
张源达,谢而付,陈旭锋,王 喆. 敌草快中毒病人脑损伤分子机制及其相关因素分析[J]. 激光生物学报, 2023, 32(5): 473-480.
ZHANG Yuanda, XIE Erfu, CHEN Xufeng, WANG Zhe. Analysis of Molecular Mechanism and Related Factors of Brain Injury in Diquat Poisoning Patients. journal1, 2023, 32(5): 473-480.