验证急性一氧化碳中毒后迟发性脑病预测概率方程的研究
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摘要
目的验证急性一氧化碳中毒后迟发性脑病(DEACMP)预测概率方程的可靠程度,评价其对该病的临床预测价值。方法以2001年1月至2014年12月豫北地区3座城市12家医院符合急性一氧化碳中毒(ACMP)诊断标准的752例住院患者为研究对象,采集患者基本信息并随访至清醒后90 d。应用秦洁等1987年10月至1990年3月从中国人民解放军海军总医院收集的被诊断为ACMP的223例患者随访结果分析中所得出的预测发生DEACMP的概率logistic回归方程,计算ACMP患者发生DEACMP的概率。预测结果与实际DEACMP发病率相比较,分析该方程的符合率及临床预测价值。结果 752例ACMP患者在随访期内实际有127例发生DEACMP,发生率16.9%,预测概率≥50%时,实际发生DEACMP者19例,明显低于理论推测发病数49例(χ~2=20.27,P<0.05);预测概率分别≥60.0%、≥80.0%、≥90.0%时,实际发生DEACMP者分别为13、3、2例,明显低于理论推测发病数37、21、8例(χ~2=19.30、25.07、8.10,P<0.05)。随着预测概率的增加,实际发生DEACMP的比率逐渐降低。预测概率越大,患者发生DEACMP假阴性率越大,灵敏度越低,假阳性率越小,特异度越高,诊断符合率越小。结论应用DEACMP预测概率方程预测本研究752例ACMP患者发生DEACMP的概率与实际发病情况符合率很低。
Objective To verify the reliability of the probabilistic equation of delayed encephalopathy( DEACMP) after acute carbon monoxide poisoning and evaluate its clinical predictive value. Methods A total of 752 inpatients with acute carbon monoxide poisoning( ACMP) were recruited from 12 hospitals in three cities in the northern part of Henan province from January 2001 to December 2014. The clinical information of each ACMP patient was collected and they were followed-up for 90 days after poisoning awake. The probabilistic logistic regression equation for predicting DEACMP was obtained from the follow-up analysis results of 223 patients diagnosed with ACMP from October 1987 to March 1990 in PLA Navy General Hospital by QIN Jie et al. The occurrence probability of DEACMP of patients was calculated; and the predicted results were compared with the actual incidence of DEACMP to analyse the accuracy of the equation and clinical predictive value. Results One hundred and twenty-seven( 16. 9%,127/752) patients demonstrated DEACMP. When prediction probability greater than or equal to 50%,the actual DEACMP patients was 19,the number was significantly lower than the theory predicts number( 49)( χ~2=20. 27,P < 0. 05). When the prediction probability greater than or equal to 60. 0%,80. 0%,90. 0%,the actual occurrence of DEACMP was 3 cases,2 cases and 13 cases,respectively; which was significantly lower than the theory predicts number( 37,21,8 cases)( χ~2= 19. 30,25. 07,8. 10; P < 0. 05). With the increasing of the predicted probability,the actual ratio of DEACMP decreased. The greater the prediction probability,the greater the false-negative rate of patients with DEACMP,the lower the sensitivity,the lower the false positive rate,the higher the specificity,the smaller the diagnostic coincidence rate. Conclusion The ACMP predictive probability equation predicts the incidence of DEACMP in 752 ACMP patients in this study is very low in accordance with the actual morbidity.
Objective To verify the reliability of the probabilistic equation of delayed encephalopathy( DEACMP) after acute carbon monoxide poisoning and evaluate its clinical predictive value. Methods A total of 752 inpatients with acute carbon monoxide poisoning( ACMP) were recruited from 12 hospitals in three cities in the northern part of Henan province from January 2001 to December 2014. The clinical information of each ACMP patient was collected and they were followed-up for 90 days after poisoning awake. The probabilistic logistic regression equation for predicting DEACMP was obtained from the follow-up analysis results of 223 patients diagnosed with ACMP from October 1987 to March 1990 in PLA Navy General Hospital by QIN Jie et al. The occurrence probability of DEACMP of patients was calculated; and the predicted results were compared with the actual incidence of DEACMP to analyse the accuracy of the equation and clinical predictive value. Results One hundred and twenty-seven( 16. 9%,127/752) patients demonstrated DEACMP. When prediction probability greater than or equal to 50%,the actual DEACMP patients was 19,the number was significantly lower than the theory predicts number( 49)( χ~2=20. 27,P < 0. 05). When the prediction probability greater than or equal to 60. 0%,80. 0%,90. 0%,the actual occurrence of DEACMP was 3 cases,2 cases and 13 cases,respectively; which was significantly lower than the theory predicts number( 37,21,8 cases)( χ~2= 19. 30,25. 07,8. 10; P < 0. 05). With the increasing of the predicted probability,the actual ratio of DEACMP decreased. The greater the prediction probability,the greater the false-negative rate of patients with DEACMP,the lower the sensitivity,the lower the false positive rate,the higher the specificity,the smaller the diagnostic coincidence rate. Conclusion The ACMP predictive probability equation predicts the incidence of DEACMP in 752 ACMP patients in this study is very low in accordance with the actual morbidity.
引文
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[2]秦洁,陈曙旸,何凤生,等.急性一氧化碳中毒性迟发脑病发病有关因素研究[J].中华预防医学杂志,1992,26(1):25-27.
[3]王玉萍,陈曙旸,秦洁,等.急性一氧化碳中毒迟发脑病预测概率的研究[J].中国工业医学杂志,1994,7(2):81-82.
[4]刘镜愉,赵金垣,史志澄.现代职业病诊疗手册[M].北京:北京医科大学中国协和医科大学联合出版社,1997:386-388.
[5]顾仁骏.急性一氧化碳中毒及其迟发性脑病的临床诊疗[J].中国全科医学,2013,16(6B):1943-1944.
[6]王伟强,王勤勇,李丽,等.一氧化碳中毒迟发性脑病危险因素分析[J].中国医药,2013,8(1):36-39.
[7]KUDO K,OTSUKA K,YAGI J,et al.Predictors for delayed encephalopathy following acute carbon monoxide poisoning[J].BMC Emerg Med,2014,14(3):1-7.
[8]HU H J,PAN X W,WAN Y,et al.Factors affecting the prognosis of patients with delayed encephalopathy after acute carbon monoxide poisoning[J].Am J Emerg Med,2011,29(3):261-264.
[9]周美宁,武涛.急性一氧化碳中毒迟发性脑病易患因素分析[J].当代医学,2013,19(21):79-80.
[10]高峰,李电申,生学明,等.急性一氧化碳中毒致迟发性脑病的临床相关因素及CT研究[J].中国临床康复,2003,7(25):3524.
[11]WEAVER L K,VALENTINE K J,HOPKINS R O.Carbon monoxide poisoning:risk factors for cognitive sequelae and the role of hyperbaric oxygen[J].Am J Respir Crit Care Med,2007,176(5):491-497.