急性草甘膦中毒的预后因素分析

目的:分析急性草甘膦中毒患者预后的影响因素,以期为急性草甘膦的预防和治疗提供参考依据。方法:本研究回顾性选取我院2009年9月—2021年2月期间收治的73例急性草甘膦中毒患者的临床资料,其中男32例,女41例;平均年龄(55.86±17.60)岁;所有患者均随访6个月。随访终点事件为全因死亡,全因死亡12例(16.4%)。按照临床结局分为存活组和死亡组,比较2组患者临床特征及实验室指标差异,将单因素分析中差异具有统计学意义的指标纳入多元logistic回归分析,得出独立预后影响因素,使用受试者工作特征(ROC)曲线检验独立危险因素在急性草甘膦中毒预后的预测价值。结果:73例患者单因素分析显示,死亡组年龄、首次医疗接触(FMC)、总胆红素(TBIL)、谷氨酰转移酶(GGT)、碱性磷酸酶(ALP)、谷草转氨酶(AST)、氯、白细胞、凝血时间均大于存活组,钾低于存活组(P<0.05);多元logistic回归分析显示,GGT、白细胞、凝血时间、年龄及接触医疗时间为急性草甘膦中毒患者预后的影响因素(P<0.05);创建新的预测模型:-21.559+0.054×GGT(U/L)+0.253×白细胞(×10⁹/L)+0.593×凝血时间(s)+0.103×年龄(岁)(>70岁=1,<70岁=0)+1.656×FMC(2 h以内=1、2~6 h=2、6 h以上=3);ROC曲线显示,预测模型的AUC为0.900,临界值为0.622,此时的敏感度为91.7%,特异度为70.5%,诊断价值优于单一指标。结论:GGT、白细胞、凝血时间、年龄及接触医疗时间是预测急性草甘膦中毒患者预后的独立危险因素,建立新的预测模型对急性草甘膦中毒患者预后具有较好的预测价值。

Analysis of prognostic factors of acute glyphosate poisoning

Objective: To analyze the prognostic factors of patients with acute glyphosate poisoning, in order to provide reference basis for the prevention and treatment of acute glyphosate poisoning. Methods: The clinical data of patients with acute glyphosate poisoning treated in Hefei Second People’s Hospital from September 2009 to February 2021 were retrospectively selected. All patients were followed up for 6 months. The end point of follow-up was all-cause death. According to the clinical outcome, the patients were divided into survival group and death group. The differences of clinical characteristics and laboratory indexes between the two groups were compared. The statistically significant indexes in univariate analysis were included in multiple logistic regression analysis to obtain independent prognostic factors. The receiver operating characteristic(ROC) curve was used to test the predictive value of independent risk factors in the prognosis of acute glyphosate poisoning. Results: A total of 73 patients were included, including 32 males and 41 females, aged(55.86±17.60) years, and 12 all-cause deaths(16.4%);Univariate analysis showed that age, first medical contact(FMC), TBIL, GGT, ALP, AST, chlorine, leukocyte and coagulation time in the death group were greater than those in the survival group, and potassium was lower than those in the survival group(P<0.05);Multiple logistic regression analysis showed that GGT, leukocyte, coagulation time, age and medical contact time were the influencing factors of prognosis in patients with acute glyphosate poisoning(P<0.05);Create a new prediction model:-21.559 + 0.054 × GGT(U/L) +0.253×Leukocyte(×10⁹/L)+ 0.593 × Coagulation time(s)+ 0.103×Age(years)(>70 years=1,<70 years=0)+ 1.656 × FMC(within 2 hours=1, 2 to 6 hours=2, more than 6 hours=3);The ROC curve showed that the AUC of the prediction model was 0.900 and the critical value was 0.622. At this time, the sensitivity was 91.7% and the specificity was 70.5%. The diagnostic value was better than a single index. Conclusion: GGT, leukocyte, coagulation time, age and medical exposure time are independent risk factors for predicting the prognosis of patients with acute glyphosate poisoning. The establishment of a new prediction model has good predictive value for the prognosis of patients with acute glyphosate poisoning.