鱼胆中毒及其并发多器官功能障碍综合征患者血浆内皮素水平的研究

目的探讨血浆内皮素(ET)在鱼胆中毒患者的变化及其与鱼胆中毒后多器官功能障碍综合征(MODS)发生及发展的关系.方法采用放射免疫法测定85例鱼胆中毒患者与30名健康人血浆ET水平,比较鱼胆中毒各组间血浆ET水平,分析鱼胆中毒患者血浆ET水平与血清酶学、血生化等指标的关系.结果鱼胆中毒患者血浆ET水平(150.5±90.5) ng/L较正常对照组(52.8±9.3) ng/L明显升高(P<0.01),轻度中毒组血浆ET水平(61.2±13.6) ng/L与正常对照组比较,差异无显著性(P>0.05),中度与重度中毒组血浆ET水平(162.3±82.3) ng/L,(232.6±92.7) ng/L较正常对照组明显升高(P值均<0.01),中度中毒组血浆ET水平高于轻度中毒组(P<0.01),重度中毒组又高于中度中毒组(P<0.01).MODS组与非MODS组血浆ET水平(210.2±98.7) ng/L,(126.3±68.3) ng/L均显著高于对照组(P<0.01),MODS组血浆ET水平又高于非MODS组(P<0.01).血浆ET与肌酸激酶同工酶、心肌肌钙蛋白I 、乳酸脱氢酶、ALT、AST、血尿素氮、血肌酐呈显著正相关(P<0.01或0.05),与肌酐清除率呈显著负相关(P<0.01).死亡组血浆ET水平(253.5±96.7) ng/L明显高于非死亡组(159.3±67.9) ng/L(P<0.01).结论 ET参与了鱼胆中毒的发病及其中毒后MODS的发生与进展.鱼胆中毒患者中毒程度越重,血浆ET升高就越明显,病死率也就越高.动态监测血浆ET的水平可作为判断鱼胆中毒患者病情轻重、预后的一个重要临床指标,对早期判断或警示鱼胆中毒后MODS的发生,并早期应用ET拮抗剂或抑制剂防治鱼胆中毒后MODS的发生发展、降低病死率有重要的临床价值.

Plasma endothelin levels in patients with multiple organ dysfunction syndrome caused by fish gall bladder poisoning

OBJECTIVE: To investigate the correlation between the change of plasma endothelin (ET) and the occurrence and progress of multiple organ dysfunction syndrome (MODS) caused by fish gall bladder poisoning. METHODS: Plasma ET was measured in 85 patients with fish gall bladder poisoning and 30 healthy controls and comparison of the levels of plasma ET was carried out between patients groups with different severity of fish gall bladder poisoning. The relationship between plasma ET levels and enzymology as well as some biochemistry indexes in patients with fish gall bladder poisoning was then analyzed. RESULTS: Plasma ET in patients with fish gall bladder poisoning (150.5 +/- 90.5) ng/L was much higher than that in controls (52.8 +/- 9.3) ng/L. The concentration of plasma ET in slight poisoning group (61.2 +/- 13.6) ng/L increased a little, but it was not significantly different with that in controls (P > 0.05). The concentration of plasma ET was significantly higher in moderate poisoning group and severe poisoning group (162.3 +/- 82.3) ng/L and (232.6 +/- 92.7) ng/L as compared with that in the controls (P < 0.01), with the severe poisoning group much higher than the moderate poisoning group and the latter much higher than the normal. At the same time, plasma ET in MODS group and non-MODS group (210.2 +/- 98.7) ng/L and (126.3 +/- 68.3) ng/L were both notably higher than that in the controls. Furthermore plasma ET in the MODS group was much higher than that in the non-MODS (P < 0.01). It was also found that a positive correlation existed between plasma ET and creatine kinase-MB, cardiac troponin I, lactate dehydrogenase, alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen and serum creatinine (P < 0.01) and a negative correlation between plasma ET and endogenous creatinine clearance rate (P < 0.01). CONCLUSION: Plasma ET may be involved in the process of fish gall ladder poisoning and later in the progress of MODS. It was shown that the higher the level of plasma ET, the severer the degree of poisoning and the higher the fatality rate. So monitoring plasma ET level dynamically may be an important clinical index in judging the patients condition and their prognosis in fish gall bladder poisoning. Simultaneously it is useful for earlier diagnosis of fish gall bladder poisoning and alertness of MODS caused by it as well as for proper management with antagonist and inhibitor against plasma ET for prevention and cure of fish gall bladder poisoning.