蝮蛇伤病人中毒程度与血清C反应蛋白的关系

目的观察70例蝮蛇咬伤患者血清C反应蛋白（CRP）水平的变化，探讨其与蝮蛇伤病情严重程度及与SIRS（全身炎症反应综合征）、MODS（多器官功能障碍综合征）发生的关系，分析蝮蛇伤患者血清C反应蛋白的变化对疾病的病情及顸后估计的意义。方法根据毒蛇咬伤的临床分型及严重程度评分标准，按患者入院时中毒的程度设轻型、重型、危重型，比较各型之间血清C反应蛋白水平的差异性；根据ACCP／SCCM提出的SIRS诊断标准，将患者分为SIRS组与非SIRS组，比较两组之间血清C反应蛋白水平的差异性；根据MODS诊断标准，将患者分为MODS组与非MODS组，比较两组之间血清酶及血清c反应蛋白水平的差异性。结果重型、危重型患者血清C反应蛋白与轻型比较，差异有显著性（P〈0.01）；SIRS组与非SIRS组血清C反应蛋白比较，差异存在显著性（P〈0.05）；MODS组与非MODS组血清C反应蛋白比较，差异存在显著性（P〈0.05）；SIRS组MODS的发生率明显高于非SIRS组，SIRS组与非SIRS组MODS的发生率比较，差异存在高度显著性（X^2=19。73，P〈0．001）。结论蝮蛇咬伤患者病情程度越重，其血清C反应蛋白升高得越明显；蝮蛇咬伤患者并发SIRS时，血清CRP升高明显，发生MODS几率升高。

The Relation of C-Reactive Protein of Sera With State of Toxicosis in Patients Bitten by Agkistrodon Halys

Objective To investigate the relation of C-reactive protein level（ CRP）of sere in patients bitten by agkistrodon halys and degree of disease severity, as well as incidence of SIRS and MODS, and to analyze the role of serum CRP level in estimation of degree of disease severity and prognosis. Methods According to clinical classification and severity degree score standard of venomous snake bitting, patients bitten by agkistrodon halys were divided into three types： mild, severe and critical type, respectively. Serum CRP level of every type in patients were compared. Patients were divided into two groups based on SIRS diagnostic criteria suggested by ACCP/SCCM：SIRS group and non-SIRS group, respectively. Serum CRP level of SIRS group or non-SIRS group were compared in patients. Patients were divided into two groups based on MODS diagnostic criteria：MODS group and non-MODS group, respectively. Serum CRP level of MODS group or non-MODS group were compared. Results There was significant difference in serum CRP level among mild, severe and critical type（P〈0.01）. There was significant difference in serum CRP level between SIRS group and non-SIRS group（ P〈0.05）. There was significant difference in serum CRP level between MODS group and non-MODS group（P〈0.05）. Incidence of MODS in SIRS group was higher than in non-SIRS group. There was significant difference in incidence of MODS between SIRS and non-SIRS （X^2=19.73, P〈0.001）. Conclusion The severer degree of disease condition in patients bitten by agkistrodon halys, the higher serum CRP level. When the patients bitten by agkistrodon halys complicate SIRS, serum CRP may markedly rise, incidence of MODS may increase.