急性百草枯中毒患者早期血浆毒物浓度检测的意义

目的探讨中毒早期血浆毒物浓度测定在急性百草枯中毒（APP）患者肝肾功能损伤程度及预后评估中的作用。方法收集军事医学科学院附属医院2006年6月至2012年6月收治的APP患者的病历资料进行回顾性分析。病例入选标准为口服中毒、未行输液及血液灌流治疗、中毒至入院时间≤6h。根据人院时测得的血浆百草枯浓度将患者分为低浓度组（〈0．5mg／L）、中浓度组（0．5～2．0mg／L）和高浓度组（〉2．0mg／L）。比较3组患者住院期间丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、总胆红素、血尿素、血肌酐水平的最高检测值和病死率。结果共收集到符合标准的APP患者87例，男性48例，女性39例，年龄9～76（30±14）岁。低浓度组31例，中浓度组27例，高浓度组29例，3组患者的性别、年龄分布和中毒至入院时间差异无统计学意义（P〉0．05）。低、中、高浓度组患者的ALT最高检测值的中位数（四分位数间距）分别为39（18，87）、126（92，249）和345（108，666）U／L，AST分别为29（25，37）、120（57，222）和233（106，361）U／L，总胆红素分别为24（18，33）、31（22，52）和65（39，86）μmol／L，血肌酐分别为77（59，136）、243（134，421）和295（248，489）μmol／L，血尿素分别为8（5，11）、15（13，21）和24（19，27）mmol／L，病死率分别为3．2％（1／31）、44．4％（12／27）和86．2％（25／29）。3组之间两两比较，上述各项指标的差异均有统计学意义（P〈0．05，P〈0．01）。结论中毒早期血浆毒物浓度可以作为评估APP患者肝肾功能损伤程度和预后的指标。

Significance of early measurement of plasma-paraquat concentrations in patients with acute paraquat poisoning

Objective To explore the significance of early measurement of plasma-paraquat concentrations in assessing the severity of liver and kidney injury and predicting the outcome in patients with acute paraquat poisoning （APP）. Methods The case reports of patients with APP in Department of Gastroenterology, Affiliated Hospital of Academy of Military Medical Science from June 2006 to June 2012 were collected and retrospectively analyzed. The inclusion criteria were as follows： the patients were orally poisoned, without undergoing infusion and hemoperfusion treatment, the time from poisoning to admission ≤ 6 h. According to the plasma-paraquat concentrations measured on admission, the patients were divided into the low-concentration group （〈 0.5 mg/L）, moderate-concentration group （0.5-2.0 mg/L）, and high- concentration group （ 〉 2.0 mg/L ）. The highest values of alanine aminotransferase （ ALT ）, aspartate aminotransferase （AST）, total bilirubin, blood urea, and serum creatinine levels detected during hospitalization in the 3 groups were compared. The mortalities in the 3 groups were calculated and compared. Results Data of a total of 87 patients were collected according to the inclusion criteria. Of them, 48 patients were male and 39 were female with age of 9-76 （30 ± 14） years. There were 31, 27, and 29 patients in the low-, moderate-, and high-concentration groups, respectively. The differences in gender, age distribution, and the time from poisoning to admission among the 3 groups were not statistically significant （ P 〉 0.05 ）. The median （ Q1, Q3 ） of the highest values of AST, ALT, total bilirubin, blood urea, and serum creatinine levels in the 3 groups were 39（ 18, 87）, 126（92, 249）, and 345 （108, 666）U/L; 29（25, 37）, 120（57, 222）, and 233（106, 361） U/L; 24（18, 33）, 31（22, 52）, and 65（39, 86） txmol/L; 77 （59, 136）, 243 （ 134, 421）, and 295 （248,489） Ixmol/L; 8（5, 11 ）, 15 （13, 21）, and 24 （ 19, 27 ） mmol/L; respectively. The mortalities in the 3 groups were 3.2% （ 1/31 ）, 44.4% （ 12/27）, and 86.2% （25/29）, respectively. Pairwise comparisons among the 3 groups were performed and the differencesin all items mentioned above were significant statistically （ P 〈 0.0 5 or P 〈 0. 0 1 ） . Conclusion Plasma-paraquat concentrations measured in the early stage of paraquat poisoning could be used to assess the severity of liver and kidney injury and predict the outcome in patients with APP.