急性有机磷农药中毒患者血白细胞、心肌酶和TNF-α的变化及其意义

目的探讨急性有机磷农药中毒（AOPP）患者血白细胞、心肌酶、肿瘤坏死因子（TNF-α）的变化及其在呼衰发生中的临床意义。方法对88例AOPP中毒患者，按病情分轻、中、重度组，重度组中再分无呼衰组、呼衰存活组、呼衰死亡组。以门诊健康体检者30例为正常对照组。受试者分别采血检测WBC、N、HCT，AST、LDH、CK、CK—MB，同时采用双抗体夹心ELISA法测定TNF-α。结果中毒患者心肌酶、WBC均较对照组明显升高，但在各中毒组间无显著差异；TNF-α较对照组明显升高，且中毒程度越重，升高越明显，在各组间有显著差异。重度中毒组中，死亡组较存活组CK—MB升高明显，呼衰组较无呼衰组CK增高明显；TNF-α在3组间有显著性差异，无呼衰组中最低，呼衰死亡组中最高。结论WBC、N、特别是TNF-α可用来判断中毒程度、估计预后。重度组中CK、CK—MB增高提示预后不良。TNF-α与有机磷中毒呼吸衰竭的发生有关。

Change of White Blood Cell Levels, Tumor Necrosis Factor and Myocardial Enzymes in Patients with Acute Organophosphorus Pesticide Poisoning and Clinlical Significance

Objective To explore the change of white blood cell levels（WBC） ,tumor necrosis factor-α（TNF-α） and myocardial enzymes in patients with acute organophosphorus pesticide poisoning （AOPP） and their clinical significance. Methods 88 patients with AOPP were divided into mild,moderate and severe groups. And severe group was divid- ed into 3 subgroups, without respiratory failure,with respiratory failure and survive,with respiratory failure but dead. WBC, TNF-α,AST,LDH, CK,CK-MB levels were measured respectively and compared with those of 30 healthy individuals. Resuits （ 1 ） Compared with the control group,the activities of serum AST,LDH,CK and CK-MB in patients with AOPP were increased significantly, but there were no significant differences among the AOPP patients. The levels of WBC and TNF-α in patients with AOPP were significantly higher than those of control group, and related with the degree of intoxication. （2） In severe poisoning group, the serum CK-MB level in patients who died finally was higher than that in survived patients. The serum CK level was significantly elevated in patients with respiratory failure compared with patients without respiratory failure. TNF-α were more evidently elevated in patients with respiratory failure than those without. The highest level happened in patients who died finally. Conclusion （ 1 ） WBC and especially TNF-α were correlated with the severity and prognosis of AOPP. （2）In severe group,the elevating levels of CK-MB and CK may display mal-prognosis. （3）TNF-α may involve in the development of respiratory failure in AOPP.